Some care services, particularly care homes, may manage the medication for people using their service. In my experience, there are several areas where ongoing caution and monitoring is required.
- There is a danger of ‘poly-pharmacy’, where multiple medications may produce the danger of unfavourable interactions.
- Over management of medication, where a person’s level of independent ability to manage their own medication is not properly assessed, and as a result their ability to do this declines.
- Care staff must be properly trained, and aware that they have a role in monitoring the medicine’s continued effectiveness.
- As a matter of common sense, alternatives to medication can be considered. For example, healthier eating, more exercise and better social opportunities may combat conditions thought to require regular medication.
The medication care plan
The Care Inspectorate in Scotland issued guidance (2012) on medication in care homes. This guidance is useful for care home services and gives details of information which should be included in the medicine care plan for each person. It is particularly important for proper support to have the following information recorded:
- When the medicine was started
- Who initially prescribed the medication
- What the medication is for
- How it is to be applied or administered
- How long the medicine has to be used for
- When it should be reviewed
- Any accompanying tests or monitoring which should be carried out
- Any changes in the medication must be recorded
I often find that care home services may not have some of this information recorded. Medicine reviews are particularly important, and the general practice may need gentle reminders when the review date for each medication comes around. The Care Inspectorate guidance describes various levels of reviews, with corresponding degree of involvement of the person themselves: prescription, treatment, and clinical reviews.
Rights, risks and limits to freedom
The Mental Welfare Commission for Scotland produced a good practice guide on “Rights, risks and limits to freedom”. Appendix 1.X and section 30 provide guidance on covert medication and medication as part of restraint. This must usually only be done with medical supervision, and where the person lacks decision making capacity.
In Scotland, if medical treatment is provided to people who are assessed as lacking decision-making capacity, care home services are required to have a medical certificate of incapacity under the Adults with Incapacity (Scotland) Act 2000, section 47. A general treatment plan must also be included as part of the overall support plan.
Links to Guidance:
Royal Pharmaceutical Society: http://bit.ly/1ok4I5x
Mental Welfare Commission: http://bit.ly/1Csew5U
