Policy briefing

Care home charter aims to improve medicines management

The Patients Association charter promotes shared decision-making

The Patients Association charter promotes shared decision-making

Many patients receive multiple medications
The charter includes guidelines for care home staff. Picture: Jamie Williamson

Essential facts

Many care home residents have complex needs and receive multiple medications, making medicines management an important safety issue.

UK research shows that residents are prescribed an average of eight medications and 70% have experienced at least one medication error.

A Patients Association survey of 30 care homes in 2015 found that in more than 70% of the homes, medication was mixed with food to make it easier to administer.

This finding raised concerns about whether residents are aware they are taking medication, the possibility of reduced or missed doses if the full food portion was not consumed and safety concerns for those with swallowing problems, or dysphagia. 

What’s new?

The Patients Association has launched a charter to improve medication practices in care homes across the UK.

The charter has two sets of guidelines, one for care home staff and one for residents and their families.

The nine-point guidelines, endorsed by the National Institute for Health and Care Excellence, are designed to promote shared decision-making, advance care planning and improve resident safety.

The residents’ guideline emphasises the importance of residents being involved in regular monitoring and review of medications, and states that medicines should only be given with their consent, unless they lack the capacity to provide it.

It states that medicines should not be hidden in food or drink, unless it is in a resident’s best interests and all legal requirements have been met.

The Patients Association’s 2015 report showed that administering medication hidden in food could result in patients having swallowing difficulties.

Crushing, melting or dispersing tablets can alter how the body absorbs medication and can increase the likelihood of side effects or reduce effectiveness.

In a pilot study of 22 care homes, 39 staff said the charter improved their confidence in how to identify swallowing problems, use of advance care plans, administration of medicine, covert administration and the laws underpinning these areas.

Implications for nurses

  • Identify and respect the resident’s wishes and beliefs about medication.
  • Involve and support the resident and/or those important to them to make shared decisions about medication.
  • Involve the resident in regular medicines optimisation reviews by a multidisciplinary team.
  • Assess, monitor, administer and review medication to ensure that the resident receives it safely and in an appropriate form and route.
  • Only administer medicines in line with local covert medication policy and the guidance of the Court of Protection.
  • Recognise and manage swallowing problems to ensure appropriate referrals are made.

Expert comment

RCN professional lead for older people and dementia care Dawne Garrett: ‘Good medicines management is important in care homes and has a significant effect on residents’ quality of life. Staff need to be trained and supported and there need to be enough nurses to ensure this happens. The workforce challenges mean that medicines management is variable. The charter is a useful document but only effective if we have enough properly trained staff to implement it.

‘Hiding medications or covert administration is never undertaken lightly and is usually the last resort. It should only be done in the resident’s best interests and as part of a formal care plan that has regular reviews and safeguards. It is not a surprise that the Patients Association found high rates of using this approach, given the complexity and needs of residents living in care homes. It demonstrates the high level of ethical and clinical decision-making by registered nurses.’

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