Frequently Asked Questions

Problems identified

Proxy Ordering Refer to care home policy.

The MOCH Team have a ‘Proxy Ordering of  Medication in Care Homes’ best practice guide to support with this topic

Proxy access was developed to allow someone other than the patient to access and manage parts of their GP online services account. The proxy is given their own online access account (rather than using the patient’s login details).

The time of ordering does not change with proxy ordering and homes should continue to reorder during the second week of the care home’s cycle. Particular attention must be taken when ordering PRN medication with a view to be preventing excess stock. If medication stock is current and within manufacturer’s date, staff should carry stock forward to the next monthly cycle to avoid unnecessary waste.

For interim/acute items care homes should continue using the care home InterimAcute request form

If a resident does not want care home staff to have proxy access to any part of their record, including repeat medication, the care home must continue using a paper-based process.

The North West Proxy Ordering in Care Homes Team held a ‘How To Do’ session on the 8th June 2021. You can watch the recorded live event here North West Proxy Ordering in Care Homes – The How to 8 June 2021

Receiving medication at the home If any errors are identified, the dispensing pharmacist must be informed immediately to ensure appropriate action is taken and that the service user has a supply of the correct medication

Ensure the documentation for the service user is accurate and up to date

  • Contact the community pharmacy if any information is missing or incorrect i.e. allergies, GP details or room numbers
Storage Refer to care home policy

CQC offer guidance for storing medicines:

Administration Only those staff who have been trained to administer medication by means of an accredited course should have responsibility for handling medication

  • Ensure staff competency and medication training is valid and up to date.

Check the MAR chart carefully:

  • to confirm which medicines are to be given
  • to confirm that none of the doses due have already been given
  • that they are to be given at the time indicated
  • that none of the prescribed doses have been changed

If there are any discrepancies, then staff should check with their community pharmacy before proceeding

Medication errors Refer to care home policy

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

All medication errors should be fully and carefully investigated taking full account of the context, the circumstances and the details of all staff involved

Further resources:

Refusals of medication. Refer to care home policy

Attempt to establish reasons for refusal

Offer medication again at a later interval

Inform relevant parties including the service user’s GP, Advanced Nurse Practitioner or MOCH Team if medication is continually refused

Swallowing difficulties Never attempt to crush tablets or open capsules if a service user is unable to swallow them

Refer to the care home manager or medicines lead for discussion with the MOCH Team

Covert medication administration Refer to care home policy

The MOCH Team have a ‘Covert Administration of Medicines’ best practice guide to support with this topic

Please note: An assessment of mental capacity and best interest meeting, as specified in the Mental Capacity Act 2005, should always be completed before the use of covert medication is considered

Controlled Drugs Refer to care home policy

Further resources:

Medication to be taken ‘when required’ or ‘PRN’ Refer to care home policy

The MOCH Team have a ‘Administering ‘when required’ (PRN) Medication’ best practice guide to support with this topic

Please note: To ensure the medication is given as intended, a specific plan for each PRN medication should be recorded in the service user’s care plan and kept with their MAR charts. This includes: inhalers, creams/gels, analgesia – e.g. Paracetamol, Co-codamol

Further resources

Medication when the service user spends periods away from the home and needs to continue taking prescribed medication that would otherwise be administered by the home’s staff Refer to care home policy

Ensure agreement with the designated carer before they leave that they will be responsible for the resident taking their prescribed medication safely in line with the prescription and care plan – give copies if necessary

Ensure documentation is relevant and up to date:

  • Information of designated carer – i.e. relative or friend
  • Medication information – including quantity given
Homely Remedies Refer to care home policy

Homely remedies should be used to treat minor ailments for residents who do not need immediate consultation with a GP, if the GP has consented to their use in principle

Homely remedies should be recorded on the service user’s MAR chart and a homely remedies record form that is kept at the home

Training All staff should read their care home 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

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. See the flyer for more information and the links to register to access the training.

CQC advises that care homes use accredited learning providers as they provide assessment of competency and knowledge. The CCG Medicines Optimisation in Care Homes (MOCH) team are not a accredited learning provider or competence assessors. We can provide teaching sessions, but care homes will still be required to have competency assessed by an accredited provider. Therefore, we recommend care homes have the training and assessment delivered together by the same provider.

Further information about a medication 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 on the home page www.cdreporting.co.uk and go to the section called ‘Useful Resources’.

British National Formulary (BNF)

National Institute for Health and Care Excellence (NICE):

Care Quality Commission (CQC)

Last updated on 16 June 2021 at 10:54 by Samantha Russell