WCH250. Re-use of End-of-life Medicines in Care Homes
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Re-use of End-of-life Medicines in Care Homes (Wales) Policy
Policy Statement
This care service acknowledges the rising concerns around the supply chain to meet increased demand for end-of-life medicines during the COVID-19 outbreak. It endorses arrangements under exceptional circumstances, to support appropriate re-use of end-of-life medicines to provide optimum care and prevent unnecessary delay and distress for service users.
This care service policy follows the Welsh Government Guidance for Local Health Boards (LHBs) and NHS Trusts on the re-use of end-of-life medicines in hospices and care homes to establish arrangements to ensure timely access to end-of-life medicines for service users in care homes and hospices via the re-use of medicines prescribed for one service user by others.
The guidance stipulates Local Health Boards (LHBs) should ensure arrangements are in place to support limited re-use of end-of-life medicines in care homes and hospices, under exceptional circumstances.
Local arrangements in this context refer to arrangements agreed by the relevant LHB for use by care homes within its area or to which it provides medicines. Where there are agreed local arrangements or pre-existing guidance, these will be followed and incorporated into individual care home policy documents. Such arrangements will also be informed by existing procedures that support the re-use of medicines in hospitals in Wales. The Controlled Drugs Accountable Officer (CDAO) and Chief Pharmacist of the relevant LHB should agree any such arrangements.
Where local arrangements are instigated to reuse medicines in care homes, this care service understands they can be used only during the current COVID-19 pandemic.
Safe storage, administration and documentation remain key and other relevant policies are followed by all staff involved.
Legislation and Guidance
The Human Medicines Regulations (2012) is the legislation that underpins dispensing and supply of medicines, supplemented for controlled drugs by the Misuse of Drugs Regulations 2001.
In accordance with the Human Medicines Regulations as amended, where a prescription-only medicine is supplied to a person in accordance with a prescription ordered by an appropriate practitioner, it becomes the property of the person named on the prescription.
In usual circumstances, this means a medicine prescribed to one person cannot then be supplied to another.
In the UK the re-use or recycling of one person’s prescribed medicines by another is not recommended as, once dispensed, the conditions under which medicines have been stored cannot be guaranteed deemed a risk in the quality, safety and efficacy of a medicine as they could potentially fall below the standard required either in legislation or by professional regulators. Unused medicines are usually returned to a pharmacy for safe disposal.
The unparalleled impact of COVID-19 resulted in the UK Department of Health and Social Care (DHSC) to relax their previous position to accommodate the re-use of medicines under limited specific circumstances as outlined in this guidance.
Where a medicine is reused, the principles of good practice for managing medicines in care homes, set out in the National Institute for Health and Care Excellence (NICE) social care guideline Managing medicines in care homes, remain in place.
Risk Assessment and Management
Medicine re-use may present additional risks to the safety of service users. Maintaining clear and accurate records is essential and managers should undertake regular checks to ensure appropriate records are being maintained as this is likely to be a significant element for future Care Inspectorate Wales (CIW) inspections. Ultimately, the CIW are likely to expect comprehensive records on the re-use of medicines and a clear audit trail maintained.
In {{org_field_name}}, a risk assessment on an individual medicine basis is carried out prior to medicine re-use. Three indicators are used, following the guidance, to inform the risk assessment and subsequent decision, which are the following.
- No other stocks of the medicine are available in an appropriate timeframe, as notified by the dispensing pharmacy and there is an urgent need for the medicine by a service user.
- No suitable alternatives for an individual service user are available in a timely manner. This could be a new prescription cannot be issued, and the medicine/s supplied against it in the conventional manner speedily enough.
- The benefits of using a medicine that is no longer needed by the individual for whom it was originally prescribed or bought, outweigh any risks for a different service user receiving that unused medicine.
The safety of service users remains paramount. By following risk assessment principles and guidance, it is feasible to support re-use of medicines in limited circumstances to avoid unnecessary delays in accessing end of life medicines.
By this means, this care service ensures service users can access the treatment they need whilst safeguarding those individuals.
Circumstances in which it may be acceptable to reuse medicines
This care service ensures healthcare professionals, carers, service users and their families, are aware reuse of medicines is for limited and exceptional circumstances where a service user needs cannot be met without causing otherwise avoidable delay and distress.
Guidance applies solely to the re-use of medicines prescribed to one person by another. It does not apply to situations where a care home is supplied stock for general use. In these situations, existing arrangements are maintained.
Storage of medicines in {{org_field_name}} enables similar assurances to hospitals regarding safe storage and record keeping for medicines.
Where local arrangements are in place to reuse medicines in hospices and care homes, this is for the duration of the current COVID-19 pandemic and re-use is only undertaken where:
- following an attempt to obtain the medicines required from a local pharmacy, out-of-hours service or the COVID-19 end-of-life medicines service, no other stocks of the medicine are available in an appropriate timeframe and an immediate service user’s need for the medicine identified
- no appropriate alternatives for an individual service user are available in a suitable time frame, ie a new prescription cannot be issued, and those medicine(s) supplied without causing otherwise avoidable delay and distress
- the benefits of reusing a medicine outweigh any risks for an individual patient
- the medicine(s) being considered for re-use have been assessed by an appropriate healthcare professional and in accordance with local guidelines, prior to being accepted for re-use.
Specified Criteria
To comply with the guidance, this care service ensures that the medicines considered for re-use are subject to rigorous physical assessment.
The medicine must also be checked by a registered healthcare professional against any specified local criteria, and include the following.
- Is the medicine deemed suitable for re-use?
- Are they in date, have they been stored correctly?
- Is the medicine a licensed medicine that has either been prescribed by a registered healthcare professional with prescribing rights or bought “over the counter”?
This care service accepts the assessments that must be undertaken must be done by a registered health care professional, defined as “a healthcare professional registered with one of the UK’s professional regulatory bodies regulated by the Professional Standards Authorities”.
Where there are no registered healthcare professional on site, this care service ensures other registered healthcare professionals, such as pharmacists, pharmacy technicians, general practitioners or community nurses, perform that check, virtually or in person, to verify the medicine is suitable for re-use or as per agreed standards of LHBs.
This care service ensures there is not unnecessary or excessive storage of medicines and that storage and record keeping requirements including any specific requirements in relation to controlled drugs are adhered to.
This care service will seek additional advice on authority to possess controlled drugs and ensure their storage requirements are compliant with Controlled Drug Accountable Officer and Chief Pharmacist of the relevant LHB.
In accordance with infection control measures, before the re-use of a medicine in relation to the re-use of any medicine prescribed to a patient with COVID-19 and minimise cross-contamination, this care service will ascertain if the medicine is from a patient with a diagnosis of COVID-19 or showing symptoms of COVID19 then that medicine will be quarantined in a secure place for a minimum of five days (or as per agreed local infection control policy) to protect both staff and service users.
The full guidance must be referred to and adhered regarding support re-use decisions.
Implementation
All staff are responsible for the safe implementation of a medicine’s re-use scheme. Responsibility for ensuring that the policy is implemented, monitored and reviewed rests with {{org_field_name}} manager and that is it only used for the duration of the COVID-19 pandemic.
Information on the policy will be:
- circulated to all staff
- provided to all new employees.
{{org_field_name}} manager will ensure that the procedures contained within this policy are followed by all staff and will ensure that all staff expected to administer medicines under the re-use scheme adhere to the guidance.
The manager will identify any areas of significant risk and take action to control this risk, promoting and demonstrating good practice associated with a medicine’s re-use scheme.
All staff administering drugs under a re-use scheme will ensure they are familiar with this policy and will be expected to follow the correct procedure when undertaking any task involving the scheme. They must report any concerns relating to the risks associated with re-use scheme to {{org_field_name}} manager or the relevant healthcare professional or pharmacist so action can be taken.
Adverse effects and problems should be reported to the LHB and clinical adverse events using the Yellow Card Centre Wales, where it should also be noted the medicine was reused. Errors should be logged using The National Reporting and Learning System (NRLS) or equivalent.
This care service ensures that in advance of a medicine needing to be reused that permission is obtained and service users, families and/or carers are informed and involved.
Training
All new staff must understand this policy, which will be introduced in their induction training and circulated to other staff members as an emerging policy to meet specific circumstances.
Staff with specific duties and responsibilities under the policy will be given the appropriate training, to ensure and maintain their competence.
Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
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