Giving care home residents a greater say in decisions about their care

This guideline provides clear advice on medicines management systems and processes that place the resident firmly at the centre of decision-making

In March 2014, we published our first piece of social care guidance to help ensure that care home residents are given a greater say in decisions about their treatment.

Care home residents to be given the same involvement in decisions about their care and support as those who do not live in care homes.

People who are admitted to care homes often have diverse needs, and depend on a range of health and social care services, meaning management of their medical treatment can be complex.

This can lead to a range of issues such as loss of independence and control as staff automatically assume responsibility for managing medicines once a resident enters a care home.

The provision of incorrect medicines also raises concerns, with a 2009 study revealing that two-thirds of residents it examined had been exposed to one or more medication errors. Further research carried out in 2011 found that more than 90 per cent of residents it studied were exposed to at least 1 potential medication administration error over a 3-month period.

To improve best practice, and ensure consistency of care, our guidance recommends that GPs, pharmacists, care home staff and social care workers, ensure care home residents have the same opportunities to be involved in decisions about their treatment and care as people who do not live in care homes. They should also be given the support they need to help them take a full part in making decisions.

The guidance also calls for all care home providers to have a care home medicines policy, which they should review to make sure it is up to date, based on current legislation, and the best available evidence.

This policy should include written processes for areas such as sharing information about medicines, keeping records up to date, dealing with any mistakes, reviewing medicines, receiving, storing and disposing of medicines.

To ensure continuity and consistency in the management of medicines, the guidance recommends that providers should have processes in place for sharing accurate information about a resident's medicines.

This information should include what is recorded and transferred when a resident moves from one care setting to another.

In addition, GPs should work with other health professionals to identify a named health professional who is responsible for medication reviews for each resident. This should take into account the clinical experience and skills of the health professional, how much they know about the resident and the resident's condition, and whether they can access the relevant information.

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."

Dr Susanna Jacks, a GP and member of the Guideline Development Group, said: "It is a challenge getting the right medicine at the right time to care home residents.

"This guideline has been developed through the collaboration of the wide range of professionals working in this field. It offers a robust framework of policies and processes so that GPs in partnership with care home staff and pharmacists can provide high quality care to this vulnerable group of patients."

Ian Turner, Chairman of the Registered Nursing Home Association, who was also involved in the development of the guidance, added: "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."

Email socialcaresh@nice.org.uk to sign up to receive our monthly social care bulletin which provides updates on all social care work ongoing at NICE.

 

New topics in the pipeline

Service user experience of social care, the care and support of older people with learning disabilities, and helping people regain independence are among the topics referred to us in January 2014 for our social care work programme.

Last year the Department of Health ran a consultation to identify social care topics suitable for developing into NICE guidelines and quality standards.

The department received more than 270 responses from a range of sources including local authorities, charities, regional clinical commissioning groups and individual services.

As a result of the consultation, the following 5 social care topics have now been referred to us:

  • Care and support of older people with learning disabilities
  • Regaining independence (reablement): short term interventions to help people to regain independence
  • Service user and carer experience: service users and carer experience of social care
  • Medicines management: managing the use of medicines in community settings for people receiving social care
  • Falls: regaining independence in older people who experience a fall.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE, said: "We welcome this latest set of new topics put forward by the Department of Health for social care quality standards and guidelines.

"The forthcoming guidelines and quality standards will be developed together with social care experts, collaborating centres and partner organisations, and will help improve integration across health, public health and social care services."

Register here to become a stakeholder and have your say on the development of NICE social care guidance and quality standards.