Summary of COVID-19 medicines guidance: Later life

For additional information, please click HERE for the Care Home Resources Hub.

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.

This page has been put together rapidly in relation to the COVID-19 pandemic.

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 28 April 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 28 April 2020

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

  • Care homes with nursing can hold stocks of controlled drugs in Schedules 3 to 5 (inclusive) as stock, as is often the case if several people are receiving end of life care. A controlled drugs licence from the Home Office is needed for controlled drugs in Schedule 2.
  • Residential homes must not hold stocks of controlled drugs. They can only hold controlled drugs prescribed and dispensed for an individual person.
  • 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 30 April 2020

This page includes guidance for a number of topics, and links to larger pieces of work:

  • This resource contains no information relating to specific medicines.
  • Multi-compartment compliance aids (MCAs) – dispensing and checking MCAs is labour-intensive and pharmacies may need to withdraw this service during the coronavirus pandemic to protect core services. Community pharmacies are not required to provide MCAs under the pharmacy contract. Care providers need to be aware that medicines in pharmacy labelled original packaging must not be transferred to MCAs, as this would be considered as secondary dispensing. However, healthcare professionals must make reasonable adjustments to help people take their medicines, as required by the Equality Act 2010, and MCAs should be still available to support people to self-administer.
  • All care homes can obtain general sales list (GSL) and pharmacy (P) medicines on a bulk prescription. They must be administered under instructions from the prescriber.

 

Care Quality Commission: Handwritten medicine administration records (MARs)

Last updated 28 April 2020

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

  • This resource contains no information relating to specific medicines.
  • Care home providers should make sure that a new, handwritten medicines administration record is produced only in exceptional circumstances. It must be created by a member of care home staff with the training and skills for managing medicines, and should be checked for accuracy and signed by a second trained and skilled member of staff before it is first used.
  • Care workers should record each time they provide medicine support. This must be for each individual medicine on every occasion. The record can look different to a standard MAR, but should be a clear record of all support provided, for each medicine. Handwritten MARs should only be made and checked by people who are trained and assessed as competent to do so. How handwritten records are made should be covered in the medicines policy.

 

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.

 

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

Last updated 12 May 2020

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

  • This resource contains no information relating to specific medicines.
  • Disposal of waste medicines is an NHS contractual requirement. People should be able to return unwanted medicines to pharmacies for disposal, which avoids the potential risk of accidents, overdoses and misuse.
  • However, during the pandemic, community pharmacies may be unable to accept waste medicines, due to capacity or infection control measures. Care providers should introduce extra measures and must arrange to temporarily store waste medicines before disposal.
  • Care providers should update risk assessments to reflect this, making sure to maintain appropriate records for waste medicines. In care homes, medicines must be stored securely with access restricted to authorised staff.
  • This page links to the NHS England / NHS improvement standard operating procedure (SOP) on running a medicines re-use scheme in care homes and hospice settings, which might affect: which medicines are suitable for disposal, and; which may need to be stored for future re-use.

 

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

Last updated 01 May 2020

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

  • This resource contains no information relating to specific medicines.
  • 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.
  • Coronavirus pressures might make it more difficult to make sure people receive timely access to essential prescribed medicines. Care 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.
  • 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, which sets out the criteria for medicines to be re-used. 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.

 

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 2 June 2020

  • 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.