Medicines Optimisation in Care Homes (MOCH)

The Medicines Optimisation in Care Homes (MOCH) Team has been created as part of NHS England’s Medicines Optimisation in Care Homes programme in line with the Framework for Enhanced Health in Care Homes. The team consists of a Pharmacist and Pharmacy Technician who specialise in care homes medicines management best practice. Our role is to work in partnership with GP’s, care home staff, health professionals and multi-agencies regarding medicines management related issues or queries. As a team, our objectives include:

  • Improving the systems around the prescription cycle
  • Reducing waste
  • Achieving medicines optimisation for care home residents through access to a clinical pharmacy team with the supporting infrastructure
  • Ensuring that residents and/or the families or carers are given the opportunity to be fully involved in decisions about their medicines
  • Improving patient care, safety and health outcomes for care home residents

Below are some of our best practice guidance and links that care home staff may find useful

Audit Templates Audit templates which care home staff may find useful to support implementation of Medicines Management guidance:

Medicines Administration Record (MAR) Chart Audit

Care Home Controlled Drug Audit

Storage of Medicines Audit

Controlled Drugs Refer to care home policy

West Lancashire Medicines Optimisation in Care Homes document: ‘Controlled Drugs – Best Practice Guidance

Providers should use this advice in conjunction with ‘The Handling of Medicines in Social Care’ (RPSGB 2007) and should check the CQC website for recent updates and refer to NICE Guidance ‘Managing Medicines in Care Homes’ SC1

Coronavirus (COVID-19) Care Homes Resources
Covert Administration West Lancashire Medicines Optimisation in Care Homes document: ‘Covert Administration of Medicines – Best Practice Guidance‘.

The flow chat should be used in conjunction with the MOCH team document, Guidance to support covert administration of medicines in adult health & social care settings.

Covert Administration – Appendix Word Documents

Implementing NICE guidelines in Care Homes
The National Institute for Health and Care Excellence (NICE) aims to improve outcomes for people using the National Health Service (NHS) and other public health and social care services by producing evidence-based guidance and advice on a range of topics, developing quality standards and performance metrics and providing a range of information services.

The Care Quality Commission (CQC) uses NICE guidelines as evidence to inform the inspection process in England.

Medicines Management focused guidance includes:

Having a system in place for becoming aware of relevant national guidance is important within care homes. Ensuring these are regularly disseminated among all suitable staff, alongside audit, action planning and review will help to ensure that care is delivered using a consistent, evidence-based approach.

Medication Oral Nutritional Supplements (ONS) – West Lancashire Medicines Optimisation in Care Homes document: ‘Oral Nutritional Supplement (ONS) in Care Homes – Best Practice Guidance‘. This recipe book is endorsed by the British Dietetic Association and aims to support creating a fortified diet to support those that have been identified as at risk of malnutrition or are malnourished. NICE also offers the guidance ‘Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition [CG32]’

Thickeners – West Lancashire Medicines Optimisation in Care Homes document: ‘Thickeners in Care Homes – Best Practice Guidance

Topical Medicines – West Lancashire Medicines Optimisation in Care Homes document: ‘Application of Topical Medicines – Best Practice Guidance‘. To support better practice with record keeping, NHS England, in collaboration with other CCGs, have developed an all-in-one Topical MAR chart.

Vitamin D in Care Homes – The Government Vitamin D scheme in January 2021 provided a one-off supply of vitamin D to all care home residents in England for 4 months. PHE and NICE guidance advises care home residents take vitamin D supplements (10mcg) throughout the year. Where appropriate using the DHSC guidance, this supply should be provided by the care home as self-care and is not to be prescribed by the GP. CQC has produced a useful guide for care homes and the MOCH team have gathered resources here.

Medicines Administration Only those staff who have been trained to administer medication by means of an accredited course should have responsibility for handling medication. If any errors are identified on the MAR, the dispensing pharmacist must be informed immediately to ensure appropriate action is taken.

Assisting people with swallowing difficulties: PrescQIPP bulletin 188 (October 2017).

Buccal Administration – West Lancashire Medicines Optimisation in Care Homes ‘Buccal Midazolam Guidance

Carrying forward medication – West Lancashire Medicines Optimisation in Care Homes document: ‘Carrying Forward Medication in Care Homes – Best Practice Guidance’

Handwritten MARs – West Lancashire Medicines Optimisation in Care Homes document: ‘Handwritten Medicines Administration Records (MARs) – Best Practice Guidance

Refused and omitted doses – West Lancashire Medicines Optimisation in Care Homes document: ‘Missed Doses of Medication in Care Homes – Best Practice Guidance

Reviewing the use of monitored dosage systems (MDS) – West Lancashire Medicines Optimisation in Care Homes document: ‘Reviewing the use of MDS – Best Practice Guidance‘. PrescQIPP bulletin 72 (August 2014) also offers additional guidance on the use of monitored dosage systems.

‘When required’ (PRN) medicines – West Lancashire Medicines Optimisation in Care Homes document: ‘When Required (PRN) Medicines – Best Practice Guidance‘. Other resources included in the document, ‘When Required (PRN) Medication Plan’ document and the Challenging Behaviour Document

Medication Errors Medication errors can happen even in the best run care service. It is important that any medication errors are reported immediately so appropriate action can be taken. The care home should have robust systems in place to highlight the steps when raising medication errors.

The Lancashire Safeguarding Adults Board has produced a ‘Guidance for Safeguarding Concerns‘ document to support care homes. Further resources regarding safeguarding and medications can be found on PrescQIPP

NHSmail The Digital Social Care Team website has several videos and guides on how to solve frequently asked questions about NHSmail. Care providers may find the following demonstration videos and information useful:

It is now possible to have more than 10 NHS email addresses per home if 10 is not considered enough and certain criteria are met. If you require further information on this please email Angela Clarke

You can also download their NHSmail User Guide for Care Providers.NHS England and NHS Improvement has also developed a NHSmail FAQs (Updated 01-Nov-21)Barclays Digital Eagles offer support to NHS staff to improve their basic digital skills and encourage care homes to embrace a more efficient digital way of working. Find out more here.

Ordering Medicines in Care Homes GP practices in West Lancashire have indicated their intention to resume a practice-based model for prescription ordering. As of Friday 1st April 2022, requests for repeat and acute prescriptions will move back in house and will be handled by your GP practice. 

If you have residents registered in multiple practices, processes will need to be established for each surgery. Contact details for the practices can be found here.

It is important that care homes have a framework for staff responsible for ordering and processing medications for residents in their care homes. Adopting an established system ensures a safe and efficient monthly prescription process that ensures compliance with NICE guidance on managing medicines in care homes,  minimises errors and waste. West Lancashire Medicines Optimisation in Care Homes document ‘Reordering Medicines – Best Practice Guidance‘ highlights the 4 key stages to the medication ordering process for care homes.

The Medication Notification Form for Care Homes template should be used when requesting items midcycle and/or for drugs not listed on the prescription form/Patient Access screen. This form should be used for all correspondences to ensure clear messages are transferred between all parties and to help reduce the possibility of medication errors.

Proxy Ordering in Care Homes: West Lancashire Medicines Optimisation in Care Homes document: Proxy Ordering of Medication in Care Homes – Best Practice Guidance. Please also see the West Lancashire CCG Policy for Care Home Use of Proxy Access

Storage West Lancashire Medicines Optimisation in Care Homes document: ‘Storage & Expiry Dates – Best Practice Guidance
Training All staff should read their care home medication policy as part of their induction. All staff should be offered training by the provider covering basic information about common medicines and how to recognise and deal with medication problems. The Skills for Care website recognises learning providers who deliver high quality learning and development to the social care sector.

PrescQIPP: Healthier Lancashire and South Cumbria ICS were successful in accessing funding for all Care Homes across Lancashire and South Cumbria to access free training around medicines for all their staff. This is a wonderful opportunity for Care Home staff to enhance their skills. The training is all online and there are 3 courses, each broken down to smaller modules. Staff can save their work and access the training at times that suit them.

If you do not already have an account, register on the PrescQIPP e-learning platform. Please select your organisation as ‘NHS Lancashire and South Cumbria Health and Care Partnership ICS’ and CCG as ‘NHS West Lancashire CCG’ when registering as this will ensure you’re provided with the correct access.

Care home staff members wishing to enroll on the e-learning course(s) will need to use licence codes to access the courses. The access codes can be found in the flyers in the links below:
Medicines use in care homes course 1 – West Lancashire CCG.pdf
Medicines use in care homes course 2 – West Lancashire CCG.pdf
Medicines use in care homes course 3 – West Lancashire CCG.pdf

Further Resources Principles of Safe Medicines Administration in Care Home setting – Interactive Guide – The purpose of this document is to provide recommendations for good practice on the systems and processes for managing medicines in care homes and is intended to be useful for staff who support individuals with medicines in care homes. Each chapter provides a summary of the key principles and is supported by further guidance where applicable. The document is intended to be used as an additional resource as the care settings feel appropriate. Audit templates and supplementary charts are available to download from www.cdreporting.co.uk. In order to access these access these templates, care home staff will need to register and go to the section called ‘Useful Resources’.

 

Last updated on 26 May 2022 at 13:51 by Samantha Russell