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NICE: Care home residents need medicines autonomy

Nurses and doctors should "assume" patients living in care homes are able to make decisions about their medicines, new guidance from the National Institute of Care and Health Excellence (NICE) has claimed. 

New guidance has been published which sets out best practice for managing medicines in care homes. The guideline makes recommendations about the systems and processes that need to be in place to ensure the safe and effective use of medicines for all children, young people and adults who live in care homes, including those who need nursing care. 

Residents should have the same involvement in decisions about their care and treatment, and should have the right to access appropriate services and support equivalent to those who do not live in care homes, NICE has said. 

It also recommends that residents have access to any support they need to enable them to take part in decision-making. This includes considering any mental health problems, any sight or hearing problems, any difficulties reading or speaking English, or any cultural differences that a person may have that might mean extra help is needed. These should be recorded in the person's care plan and should be checked regularly. 

Other recommendations in the NICE guideline on managing medicines in care homes include: 

 - All care homes should have a written policy that they follow, which gives information about how staff in the care homes should: 

   - Share information about medicines 

   - Keep records about medicines 

   - Deal with any mistakes that might happen when people who are living in a care home are given their medicines 

   - Review and accurately list the medicines someone is taking 

   - Order, receive, store and dispose of medicines 

   - Give medicines to people in their care. 

 - Health professionals who prescribe medicines should assume that people who live in care homes are able to make decisions about their own medicines. However, if a health professional is concerned about a person's ability to make such decisions, they should check whether the person is able to understand why, for example, a new medicine is needed before offering it. 

 - Providers of health or social care services should have processes in place for sharing accurate information about a resident's medicines including what is recorded and transferred when a resident moves from one care setting to another (including hospital). 

 - Commissioners and providers of health or social care services should ensure that a robust process is in place for identifying, reporting, reviewing and learning from medicines errors involving residents. 

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE said: “Care home residents are often vulnerable and often have complex medical needs requiring them to take a number of medicines. This sometimes makes them particularly dependent on care home staff to help them take their medicines. 

"This guideline provides clear advice on medicines management systems and processes that place the resident firmly at the centre of decision-making, ensuring that their needs are paramount and can be addressed safely and effectively.” 

Ian Turner, chairman of the Registered Nursing Home Association and member of the Guideline Development Group said: "Moving towards a situation where we have more commonality around managing medicines in care homes and better standards has got to be a significant step forward. It will mean that any issues with medicines are picked up early and that homes are better supported. 

"The medicines review process needs to entail better communication between the pharmacist, care home and GP. Currently we are still moving towards understanding how often residents should have their medicines reviewed and what that review should involve. This guideline will be extremely helpful in providing clarity around this issue, and in ensuring that medicines reviews are meaningful to everybody. For individual residents, this means they will be on an optimum medicines regime. And, if you can reduce the number of medicines, the problem of volume becomes easier in the care home.” 

The guideline also covers the processes for reviewing medicines, prescribing and ordering medicines, dispensing and supplying medicines, receiving, storing and disposing of medicines, administration of medicines by care home staff, the covert administration of medicines, and the administration of medicines for minor ailments that can be bought without prescription, such as paracetamol for headaches or remedies for indigestion. 

The guideline is available to view on the NICE website