Improved access to key medications within care homes would help alleviate ‘suffering’ experienced by residents and ‘significantly improve’ end-of-life care, nurses have urged.
The Royal College of Nursing (RCN) Congress has seen a resolution passed calling for amendments to the law that would enable enhanced access to controlled drugs in all care homes.
Controlled drugs – which include those used to treat pain such as morphine and diamorphine – are subject to strict oversight under the Misuse of Drugs Act 1971, and require care homes to follow regulations on the safe storage and administration of these medications.
Care homes without nursing cannot store controlled drugs unless they are prescribed for individual residents as per the Act and licensing rules for care homes with nursing means there can be challenges around the timely availability of medications.
In a debate held yesterday, nurses said one of the primary issues was the absence of provisions allowing care homes to maintain a generic supply of controlled drugs, similar to those available in hospital settings.
Nurses warned that this reduced access to pain-relieving medication and risked placing additional distress on those living in care homes.
The resolution, submitted by the RCN Pain and Palliative Care Forum, underscored the need to address current regulatory barriers and amend the legislation.
Speaking during the debate, Stephanie Craig, co-chair and board member of the RCN Older People’s Forum, said: ‘We need to have systems in place which reflect a whole system approach to care.
‘Changing the law to allow care homes to store controlled drugs would significantly improve end-of-life care.
‘This is vital to ensure equitable and high-quality care for residents at their most vulnerable time.’
Bernice Anoquah, from within the RCN’s Southeastern region, said policies around controlled medications meant ‘people are suffering’ within care homes, and described the sadness of seeing residents dying in pain ‘all because they don’t have enough medication’.
Concerns were also raised around the provision of pharmacies, with nurses explaining the impact of not having access to controlled drugs and having to wait for pharmacies to be open and available.
Marie Rogers, from the District and Community Nursing Forum, said: ‘As a community nurse, I do see issues with accessing pharmacists. Pharmacists are closed earlier and earlier, pharmacists are hard to find.’
However, she also expressed ‘worry’ about increasing controlled medicine access in care home settings if nursing home staff were asked to ‘make decisions’ that advanced nurse practitioners or prescribers would usually make.
Speaking from the congress panel following the debate, Linda Bailey, vice chair of RCN Congress, told how her mother’s death in hospital would have been made ‘so much easier’ if she had access to controlled pain medications.
She explained that when her mother’s condition worsened on the Friday night, the hospital team was unable to access the pharmacy it used for controlled drugs as it was closed for the weekend.
‘My mother’s passing 48 hours later, late on Sunday afternoon, would have been made so much easier if she had medazepam and diamorphine, but I had to watch her struggle for every breath in her last few hours, it was very painful for me,’ added Ms Bailey.
Community end-of-life care ‘a postcode lottery’
As part of the debate, nurses also expressed their concerns about the wider provision of end-of-life care.
Sharlene Hogan from the RCN’s Advanced Practice Forum said: ‘There is a massive postcode lottery in terms of access to end-of-life care in community settings, compounded by a lack of access to one’s own GP when entering care home environments.’
She suggested that ‘timely referrals’ to urgent care response teams and GPs would help ‘reduce the need for emergency access to end-of-life medication’.
Meanwhile, Denise Chaffer, former RCN president and current RCN member, said: ‘I think there’s a really big issue here in the access to primary care and palliative care which is massively depleted.’
She referred to the ‘huge variety’ of care quality across care homes, describing how unregulated care home staff meant ‘safeguards’ would be needed if controlled drugs were made more widely available within these settings.
Despite a number of abstentions within the conference hall, the resolution – ‘That this meeting of RCN Congress Calls on RCN Council to lobby governments to amend the law to improve access to controlled drugs in care homes’ – passed overall.
RCN Congress, which is being held in Newport this week, has seen other debates on the poor state of GP practice buildings and around the need for more support to help nurses raise concerns and to be given more continuing professional development opportunities.
