13 September 2011
In July 2011 the learning report from the Health Foundation project ‘Making care safer – Improving medication safety for people in care homes: thoughts and experiences from carers and relatives’ was published.
The issues and possible solutions identified are presented in the report under four main themes:
- Communication and information sharing
- Prescribing and administration of medication
- Staff development and support
- Advocacy and rights.
The issues below were relevant to all themes and were mentioned consistently:
- Build strong trusting relationships as these are fundamental to how well care is delivered
- Take time to communicate, update records, and share information
- Ensure regular and formal reviews of care plans and medication
- Prioritise safety by protecting the drugs round, improving systems and attention to detail
- Identify, capture and develop good practice and help disseminate this to staff
- Make use of relevant health professionals to ensure medication practices are safe
- Clarify roles and responsibilities to ensure smoother communication and safer care
- Consider medication as part of a holistic approach to care to ensure that decisions are always made in the interests of the resident and their voice is heard.
The initial project is now being taken forward in an integrated programme led by the National Care Forum, and funded by the Department of Health, working as part of a wider cross-sector partnership with influential organisations in this area of care. The next phase of the programme aims to deliver an improvement project over nine months.
Residents in care homes are a group vulnerable to medication errors, in addition to interactions and side effects from their medicines. Action plans to assess, and where appropriate, improve medication safety for people in care homes should be seen as a high priority for medicines managers in localities.
In October 2009, the CHUMS study, funded by the Department of Health, found unacceptable levels of errors in the medications received by care home residents, affecting some of the most vulnerable members of society (average age 85 years). It found that seven out of ten residents experienced at least one medication error. The prevalence of prescribing errors was 8.3% with the most common error being ‘incomplete information’ (38%). The prevalence of medication administration errors was 8.4% with nearly half of them being ‘omissions’. The prevalence of dispensing errors was 9.8%; and for monitoring errors for medicines that required monitoring, 14.7%.
The ‘Making Care Safer’ project commenced in 2009 following publication of the CHUMS study.
What did the project do?
The Health Foundation collaborated with Age UK, the Royal College of Physicians, the Royal College of General Practitioners and the Royal College of Psychiatrists to gain an understanding of carers’ perspectives of medication safety in care homes. Past and present carers attended focus groups where they described their experiences and identified possible ways to improve medication safety in care homes. Attendees also considered what improvements could be made given the current culture and constraints in the NHS, as well as what could be done strategically in the longer term.
How does this relate to other publications or evidence?
The Royal Pharmaceutical Society of Great Britain (RPSGB) guide ‘The handling of medicines in social care (2007)’ provides best practice guidance based on current legislation governing the handling of medicines in the social care environment.
In response to the CHUMS study, on the 7th January 2010, the Department of Health sent a letter to all PCT chief executives and medical directors, SHA pharmacy and prescribing leads, and SHA nursing and medical directors, strongly encouraging them to work together to review their systems and ensure they comply with the principles set out in the RPSGB 2007 guidance, as well as the ‘Care Quality Commission (CQC) standards (2009)’.
What does this mean to medicines management?
Residents in nursing and residential care homes represent one of the most vulnerable populations in the UK and often have multiple medical conditions. As identified by the CHUMS study, they are at particular risk from medication errors and, as the personal experiences shared by relatives and carers in ‘Making Care Safer’ demonstrate, there are many opportunities for healthcare professionals, managers and staff to introduce change and improvement in the care they provide.
The feedback from carers and relatives in the ‘Making Care Safer’ report identify that care home staff should be encouraged to build closer working relationships, particularly with the health professionals, relatives and carers of the residents they are caring for. The report highlights that staff should be supported to do so through appropriate training networks’ that can help them to improve their team-working and communication skills. Additionally, care home managers and leaders need to ensure adequate staffing levels and establish a happy working environment where staff morale can improve and turnover can decrease.
In conclusion, care home staff need to be aware of the importance of managing medicines safely; be confident to recognise and deal with problems as they occur; and be encouraged to report and learn from previous incidents through the National Reporting and Learning Service.
Further information that can support medicines management improvements in care homes can be found on NHS Evidence and in the following e-learning sections of the NPC website: Medicines management in care homes; Improving safety and managing risk in medicines management systems and processes; Medicines management for long-term conditions; Medicines reconciliation; Developing effective communication skills; Effective team working; and Working with others.
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