Summary of COVID-19 medicines guidance: Later life

Abigail Scott, Regional Medicines Information Pharmacist, Midlands and East Medicines Advice Service (East site)Published Last updated See all updates

This page summarises and signposts to medicine related guidance we’re aware of from professional and government bodies relating to coronavirus and later life disorders.

Our advice is constantly reviewed as the pandemic situation evolves.

Whilst we have tried to ensure that the information on this page is complete, please report a concern if you feel anything is omitted or inaccurate.

To see our professional guidance summaries for other clinical areas, click here

Advice in this area includes:

NHS England/NHS Improvement. Novel Coronavirus (COVID-19) standard operating procedure. Running a medicines re-use scheme in a care home or hospice setting v1

Last updated 2 September 2020

Our summary

This medicines re-use SOP for care homes and hospices is a time-limited SOP and would apply only during this period of emergency. The SOP –

  • Provides criteria for assessing medicines against and the conditions in which this might be acceptable.
  • Applies to medicines that have been supplied to patients while in a care home or hospice, have not been removed from that setting (other than for short periods of up to 24 hours) and have been stored in accordance with good practice guidance on storing medicines in a managed setting.
  • Applies to all medicines including liquid medicines, injections (analgesics, insulin), creams and inhalers that are in sealed or blister packs, when appropriate criteria are met.

 

Care Quality Commission: Controlled drugs as stock in care homes

Last updated 01 April 2021

The guidance on this page has been updated to include general guidance around managing CDs in a care home situation.

Specific information applicable to the coronavirus (COVID-19) outbreak is as follows:

  • During the coronavirus pandemic, there have been calls for care homes to be able to keep anticipatory medicines for end of life care, intended for use when a normal supply might not be possible. The decision to place medicines in care homes as anticipatory stock needs to be balanced with the impact of increased demand on the medicines supply chain. NHS England advise that care homes should not routinely hold anticipatory medicines stock, and supplies should be centralised as much as possible. Some Clinical Commissioning Groups (CCGs) have already established local hubs to ensure safe, legal and rapid access to anticipatory medicines. The CCG medicines optimisation teams are central to this action and should work with providers and healthcare partners to ensure rapid access to end of life medicines for people in care homes.

 

Care Quality Commission: COVID-19: medicines information for adult social care providers

Last updated 20 July 2020

This page links to larger pieces of work but no longer contains any specific guidance itself.

 

Care Quality Commission: Inappropriate use of sedative medicines to enforce social distancing guidelines

Last updated 9 July 2020

The guidance on this page applies during the coronavirus (COVID-19) outbreak.

  • This resource contains no information relating to specific medicines.
  • It advises however that providers must make sure that people’s behaviour is not controlled by excessive or inappropriate use of medicines. The authors do not advocate the use of sedative medicines or physical restraint to deprive people of their liberty.
  • The principles of the Mental Capacity Act and the safeguards provided by the deprivation of liberty safeguards still apply. A link is provided to a document published by the Department for Health and Social Care on The Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) During the Coronavirus (COVID-19) Pandemic. (This specific guidance was withdrawn on 10th August 2021, but it is still available on the Department of Health and Social Care website).

 

Care Quality Commission: Medicines disposal during the coronavirus (COVID-19) pandemic

Last updated 03 Feb 2020.

The guidance on this page no longer includes specific advice for the coronavirus (COVID-19) outbreak and has been backdated to 03 Feb 2020.

 

Care Quality Commission: Re-using named patient drugs as medicines supply

Last updated 02 July 2021

The guidance on this page applies only during the coronavirus (COVID-19) outbreak.

  • This resource contains no information relating to specific medicines.
  • The authors remind users that the Human Medicines Regulations 2012 underpin dispensing and medicines supply.
  • Prescription-only medicines (POMs) must only be supplied on prescription to a named person. Once prescribed, the medicines become the property of that named person. The person must not supply that POM to anyone else. Therefore prescribed medicines cannot be used for anyone else.
  • This document links to the NHS England / NHS improvement standard operating procedure (SOP) on running a medicines re-use scheme in care homes and hospice settings, for use during the COVID-19 pandemic only, which sets out the criteria for medicines to be re-used. It must be checked by a registered healthcare professional.
  • This scheme should only be considered where there is an immediate need for the medicine, and either: no other stocks are available, or no suitable alternatives exist for an individual. A risk assessment should be carried out on an individual medicine basis.
  • Healthcare staff need to act in a way that is pragmatic and safe, and focus on what is in the best interest of their patients and the wider system. Local schemes on medicines re-use may already be in operation to support this.

 

British Geriatrics Society: COVID-19 and medicines advice for older people 

Last updated 17 March 2020

  • This short guideline notes that consideration should be given to temporarily withholding diuretics, ACE inhibitors/angiotensin receptor blockers, NSAIDs and/or metformin in patients whose fluid intake has been reduced by illness.

 

British Geriatrics Society: COVID-19: Managing the COVID-19 pandemic in care homes for older people

Last updated 18th November 2020

Also contains updated information about testing, use of oxygen, and subcutaneous fluids.

  • Dexamethasone therapy is associated with improved survival and clinical outcomes in people with severe COVID. It should be considered for use in a care home, where oxygen therapy is being used to treat a care home resident with COVID-19. Where given, dexamethasone 6mg once daily should be administered orally for ten days in keeping with current guidance from the National Institute of Health and Care Excellence; advice is given on managing residents with diabetes (including times for capillary blood glucose measurements) and monitoring for signs of agitated delirium.
  • Consideration of thromboprophylaxis may be necessary and should be tailored to the potential risks and benefits for an individual resident.
  • Care homes should work with GPs and local pharmacists to ensure that they anticipate palliative care requirements and order anticipatory medications early in the illness trajectory. It is not possible for care homes to hold a stock of anticipatory medications for use when residents are approaching the end of life. Working collaboratively, care homes, GPs, and local pharmacists can recognise and anticipate residents who are approaching the end of life and ensure that anticipatory medications are prescribed in a timely fashion.
  • Recent changes to government legislation mean that care homes can reallocate unused palliative medications, after a resident has died, to another resident who might need them. In practice, the steps required to do this are complex and require input from a pharmacist and a prescriber, usually a GP. Care homes should develop Standard Operating Procedures, working with their local pharmacists and their clinical lead, to support this.

 

Joint guideline from British Geriatrics Society, European Delirium Association, and Old Age Psychiatry Faculty (Royal College of Psychiatrists): Coronavirus: Managing delirium in confirmed and suspected cases

Last updated 25 March 2020

This consensus advice should be used in conjunction with local policy and governance practice employed within your own organisation. Includes hyperlinks to guidelines referenced. Medication advice includes:

  • Reduce the risk of delirium by avoiding or reducing known precipitants, including: avoiding constipation, treating pain, avoiding urinary retention and medication review.
  • Where these interventions are ineffective or more rapid control is required to reduce the risk of harm to the patient and others, the authors would recommend the guidance provided in SIGN guideline 157, but in more urgent situations would advise referring to the NICE Guidance on Violence and Aggression.
  • If patients are treated using the NICE rapid tranquillisation interventions (p63), monitor for side effects, vital signs, hydration level and consciousness at least every hour until there are no further concerns about the person’s physical health. Be mindful of use of benzodiazepines with respiratory depression.
  • The authors suggest a more conservative approach for dosing of haloperidol in older adults, with a maximum 2mg in 24 hours in the first instance, even though the BNF max dosage is 5mg in 24 hrs. Where higher dosages are required please seek specialist advice.
  • Caution with use of medication in older people, and especially certain medications in people with Parkinson’s disease or dementia with Lewy bodies (e.g. antipsychotic medication)
  • The appendix includes a table of medications that may be used in delirium, with appropriate doses, and cautions.

 

Change history

  1. Resources checked and information remains correct.
  1. Dates for CQC documents updated.
  1. Minor edit to bring information on re-using named patient drugs as medicine supply into line with CQC page, and amended last updated date for CQC page.
  1. Published