Top tips for managing medicines for adults receiving social care in the community
This resource for GPs and pharmacists is part of the Involved and informed: good community medicines support campaign. The campaign encourages key audiences to take specific actions from NICE's guideline and quality standard on managing medicines in the community. It has been developed collaboratively by several partner organisations, including the RCGP and RPS encouraging multidisciplinary collaboration.
The NICE guidance itself focuses on safe and appropriate medicines support for adults living in their own homes, with the importance of people retaining full responsibility for their own medicines, when possible, being central to it.
Include the person in decisions about their medicines, and when appropriate include their carer, family or advocate
Include the person in any decisions about their medicines where possible. This includes starting, stopping and changing doses or formulations of medicines they take. Ask them who they want to support them and document this in the appropriate patient record.
Consider family members, informal/formal carers, care coordinators or advocates, ensuring you then support and respect their choices.
Follow shared decision-making principles and ensure medicines reviews are centred on the person’s needs and preferences
When performing medicine reviews, full and comprehensive medicines reconciliation is crucial. Include alternative remedies and over-the-counter medicines, ensuring that treatment options are fully explored, along with their risks and benefits. Take into account the person’s beliefs and values when discussing the choices available to them, documenting them for future reference using shared care decision making principles when possible.
Explaining why each medicine is being taken is essential. Determine if they currently receive, or feel they need any medicines support and remember that carers, family and advocates can provide valuable feedback so consider including them in the review.
Discuss the most appropriate form of medicine to prescribe. For example, if there are difficulties swallowing tablets, consider whether the medicine can be crushed or dissolved, if there is an alternative preparation available, whether the medicine could be stopped or the regimen simplified.
Ensure information is always provided in an accessible manner to ensure that the person and/or those supporting them, understand the information shared including the use of decision aids where appropriate.
Include care providers in multidisciplinary discussions where appropriate
If the person consents, offer to include care providers (e.g. family members, informal /formal carers, care coordinators or advocates etc.) in multidisciplinary discussions. This may help to understand the person’s needs and help you as a clinician when discussing on-going treatment options.
Give care providers advice and support about medicines
It is the responsibly of health and social care commissioners/ providers to ensure it is clear who is accountable and responsible for providing medicines support in your local area. The level of training and expertise of home care providers varies considerably, and so understanding the limits of the medicines support in your area is essential. Carers must work within their competency range and, like all other health care professionals formal (paid) carers are bound by the limits of their registration. Some will be able to administer medicines, whereas many will only monitor or prompt people to take them.
It is important that information about medicines is shared with the person and their family members or carers to support high-quality care. NICE recommends that clear written instructions should be given when medicines are prescribed and that a patient information leaflet for each drug be available (including for those drugs in monitored dosage systems).
Whether a person is self-medicating or a care provider is providing medicines support, specific written advice on how the medicine should be taken must be provided on the prescription, the dispensing label and the Medication Administration Records (MAR) charts if one is in place. This information should include
- Indication, dose, formulation, strength and agreed time it should be given
- Additional information such as whether the medicine needs to be crushed, dissolved, or taken with food
- When prescribing“as required” medication, the minimum time between doses and the maximum number of doses in a 24-hour period should also be added.
Tell patients and care providers when medicine changes are made and when it will be changed
Prescribers should always inform the person or their named contact of any medicine changes, including when stopping or starting a medicine. Written instructions detailing changes or a new prescription should be issued following any change.
If changes are made verbally, to avoid delays in treatment, prescribers should provide written confirmation as soon as possible.
The MAR chart (if in use) should also be updated with any changes. This can be completed by the social care provider, pharmacist or dispensing GP as determined by local policies.
A needs assessment should be completed before a monitored dosage system (MDS) is used and this should be reviewed regularly
Wherever possible, medicines should be supplied in their original packaging, making any necessary reasonable adjustments to help the person self-medicate. If a person is not managing, other interventions should be considered, such as:
- Medicine review to reduce inappropriate polypharmacy/ simplify the regimen
- Patient counselling / information sheets to improve understanding of medicines-use
- Use of reminder charts or alarms (as a memory aid)
- Use of medicines administration record (MAR) charts
- Labels with pictograms or large print
- Information sheets
- Reminder alarms
- Easy open containers
- IT solutions and new technology such as phone apps and telemedicine.
If these interventions are not enough, using shared decision making principles, a trial of a compliance aid (MDS) may be required. This is just one additional intervention and is not suitable for all people. “As required” medicines, medicines that require frequent dose changes (e.g. warfarin) or medicines given via non-oral routes such as inhalation or topical preparations are not suitable to be included in an MDS.
The compliance aid should be regularly reviewed to ensure it is helping the person and that they can still manage their medicines with it. A person’s needs may change over time. If they are no longer able to manage their medicines independently and need a carer to support them, a compliance aid may no longer be required and reverting to original packs should then be considered.
People who receive a complete month of medicines in a MDS still need to have any changes made in a timely manner. When a new medicine is added, a medicine is stopped or a dose is changed, the compliance aid should be returned to the pharmacist/ dispensing GP with the new prescription to ensure those changes can be made.
Record details of medicines support in a person’s medical record
The details of the medicine support a person requires and who to contact about their medicines (the person or their named contact) should be clearly documented in the appropriate patient record.
More information on the Involved and Informed campaign can be found at https://www.nice.org.uk/news/article/involved-informed-good-community-medicines-support