Care Homes and COVID-19: Medicines administration issues

Tiffany Barrett, Interim co-director, South West Medicines Information and Training, NHS England SouthPublished

There are a number of medicines administration related enquiries that you may be asked to help with when working with patients and staff in care homes. These include –

  • Simplifying complex dosage regimes
  • Alternative formulations for patients who are not able to swallow tablets/capsules
  • Principles and best practice in relation to covert administration of medicines
  • Use of hand written medication administration record (MAR) charts

We have signposted to some key resources to help you deal with the most common queries –

1. Simplifying complex dosage regimens

Specialist Pharmacy Service (SPS): Practical steps to amending medication dosage regimens in care homes during COVID-19

Version 1. Produced May 2020

Our summary

  • This document gives advice on factors to consider when changing medication dosage regimens of care home residents to reduce the frequency of administration during COVID-19.
  • It is aimed at registered healthcare professionals supporting care homes. The objectives are both to protect residents from unnecessary contacts during medication rounds, and to assist with staff capacity.

2. Swallowing issues

Key resources for answering questions about alternative formulations of medicines include –

  • BNF
  • SPC
  • Drug Administration via Enteral Feeding Tubes is accessible on Medicines Complete through a free Open Athens account. Instructions for how to register for this and access the resource can be found here.

The SPS website has a number of useful Medicines Q&As on this topic including –

There are also two resources on the SPS website that provide more background on the management of dysphagia and the need to consider alternative formulations –

SPS: (webinar) Administering medicines to patients with swallowing difficulties

Last updated June 2018

Our summary

  • This webinar covers what is dysphagia and how pharmacists can utilise SLT recommendations for fluids consistency and food textures to amended oral formulations to allow for appropriate and safer medication administration

SPS: Supporting patients with swallowing difficulties – medicines and dysphagia

Last updated March 2017

Our summary

  • This resource is intended to support the pharmacy team and those who are involved in administering medication to patients with dysphagia through supporting the selection of the most appropriate method of administering medication.

Care Quality Commission: Dysphagia and thickeners

Last updated 27th January 2020

Our summary

  • A brief summary of the key points to consider when someone has difficulty swallowing and thickening agents are being considered.
  • Key questions to consider when reviewing patients with dysphagia are considered

Care Quality Commission: Enteral feeding and medicines administration

Last updated 14th July 2020

Our summary

  • A brief overview of the issues around the administration of medicines via enteral feeding tubes as well as a summary of the different enteral feeding tubes used

3. Principles and best practice in relation to covert administration of medicines

Two excellent resources on this topic are –

Care Quality Commission: Covert administration of medicines

Last updated July 2020

Our summary

  • This resource provides best practice principles and examples in relation to covert administration including circumstances where covert administration may be or may not be appropriate and how to ensure that these actions remain in the best interests of the person
  • The guidance also highlights pharmaceutical considerations; e.g. that administering medicines in food or drink can alter their therapeutic properties and effects crushing a tablet or opening a capsule before administration may make its use off-license.

SPS Medicines Q&A What legal and pharmaceutical issues should be considered when administering medicines covertly?

Last updated Nov 2017

Our summary

  • Covert administration of medicines is a complex issue and involves disguising the administration of a medicine (e.g. in food or drink) to a patient lacking the capacity to consent to treatment.
  • This Medicines Q&A discusses some of the legal issues that need to be considered before medicines are given covertly.
  • It also addresses some of the pharmaceutical issues (e.g. absorption, incompatibility, interactions) and patient factors (e.g. acceptability) that need to be considered when deciding whether to administer medicines in this way.

4. Use of hand written medication administration record (MAR) charts

The Care Quality Commission: Handwritten medicine administration records (MARs)

Last updated 28th April 2020

Our summary

  • This resource provides advice for circumstances when a written MAR chart may be required to maintain a good record of medicines administration
  • It links to NICE guidance for managing medicines in care homes and also managing medicines for adults receiving care in the community

Administration update (17th July 2020): One resource updated (see red highlight)

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