- Managing Prescriptions
- CAS Alert: Syringe Driver Pumps
- Changes to pregabalin and gabapentin
- Over the counter
- Homely Remedies Guidance
- Medicine Pots
- Bulk Prescribing
- Covert Administration of Medicine
- Application of Patches
- Online ordering
- Novel Oral Anti-Coagulants (NOACs)
- Management on Transfer
- Medicines and Falls Risk in Care Homes
- Recording, Maintaining and Sharing Drug Sensitivity/ Allergy Information
The intended operation of these pumps cannot be verified due to errors in the instructions for use (IFUs) and incompatibility with older versions.
Following the release of the 3rd edition T34 pump, MHRA has received reports of problems associated with using it. This involves, but is not limited to:
- errors and inconsistencies in the instructions for use
- incompatibility of the BodyCommTM 88-102 software with 3rd edition pumps
- changes to battery life
- use implications due to change in device interface
2nd edition T34 syringe driver pumps (the previous version) are still affected by separate corrective actions addressing the following issues:
- sunlight protection (MDA/2016/002)
- battery connection issues (MDA/2019/013)
- fluid ingress checks (MDA/2019/030)
- Identify whether you have any 3rd edition T34 syringe driver pumps (see device details section in the attached CAS alert).
- Identify patients currently receiving treatment supported by these pumps.
- Identify all relevant healthcare professionals involved with care delivery using these pumps and advise them to discontinue using the device when clinically appropriate.
- BD/CME will contact you directly regarding the BodyComm V3.0 software and when the updated version of the IFUs are available.
- Once you receive the updated IFUs, make sure users are aware of the revised intended use of the pump and other performance specification changes from the previous, 2nd edition, T34 syringe driver pump. BD/CME offers training if required.
All technical staff responsible for servicing these devices and healthcare staff who use these pumps.
Deadline for actions
Actions underway: 05 November 2019
Actions complete: 19 November 2019
Click to view the device details and the full CAS alert
Thank you to Care UK Knebworth for this very helpful image.
Pregabalin and Gabapentin will be classed as Schedule 3 controlled drugs from 1st April.
The reclassification follows Government consultation and recommendations from the Advisory Council on the Misuse of Drugs for additional safeguards to be put in place because of concerns around the misuse of these drugs. However, pregabalin and gabapentin will be included in the list of “exempted drugs” in the safe custody regulations which means that care homes will not be required to keep these drugs in the CDs cabinet.
From 1st April 2019, all gabapentin and pregabalin prescriptions will be subject to the following prescription writing requirements for Schedule 3 CDs:
- Patient name and address
- Prescriber’s address
- Prescriber’s signature
- Date of prescriber’s signature
- Drug name, strength and formulation
- Dose (Note: ‘as directed’ is NOT acceptable; ‘one as directed’ is acceptable)
- Total quantity (in both words and figures)
Further guidance can be found here
Please note: Care Homes will still need to sign for them when delivered or collected from pharmacy
Residents in care homes who need an over-the-counter (OTC) medicine
Following the results from a public consultation in 2017, East and North Hertfordshire CCG implemented a policy that medicines that can be bought over-the-counter to treat minor illnesses and short-term conditions will no longer be routinely prescribed by GPs. The same policy is also in place in the Herts Valleys CCG area and NHS England has issued national guidance on conditions for which over the counter items should not be routinely prescribed in primary care.
People are advised to purchase these medicines when they are needed and obtain advice from a pharmacist who has the clinical expertise to help them to manage their symptoms.
Good Practice Guidance Prescribing Over the Counter Medication - Herts Valleys
Good Practice Guidance Prescribing Over the Counter Medication - East and North Herts
Please click here to read full guidance covering- exception criteria and guidance.
If your care home does not have a ‘homely remedy’ policy in place, please contact your local CCG pharmacy team and who will advise you:
East and North Herts CCG: 01707 685207
Herts Valleys CCG pharmacy team: 01442 898888
What is a homely remedy?
Homely or household remedy is another name for a non-prescription or over the counter (OTC) medicine which is used in a care home for the short term management of minor, self-limiting conditions. Minor conditions will include conditions such as cold symptoms, headache, occasional pain or indigestion. This guidance aims to ensure that access to treatment for minor ailments is as it would be for a patient living in their own home. They can be obtained without a prescription and are usually purchased by the care home. Where a non-prescription or OTC medicine is purchased by the resident or relative.
EN Herts CCG Homely Remedies Policy:
- The previous ENHCCG Homely Remedies guidance recommended that the GP practice is made aware when a homely remedies process is active in the care home. This has now been updated to include that advice on the use of homely remedies should be taken for each resident in advance or at the time of need, this can be at the time of new resident admission. Advice should be taken from a healthcare professional, such as a GP or pharmacist (or care home nurse).
- This is in line with current CQC guidance.
- There is a homely remedy authorisation form template within the document which care homes/ GP practices can adopt.
- It also includes further guidance around the checks that care home staff should take before making a decision to administer a homely remedy.
Please be aware of references to Homely Remedies with Anti Coagulants-
NOACs ( novel oral anticoagulants), sometimes called DOACs (direct oral anticoagulants) are a new group of anti-coagulants and are an alternative to warfarin. NOACs include – apixaban, edoxaban, dabiagatran and rivaroxaban. They are prescribed for several reasons including:
- Atrial Fibrillation (AF)
- Recent hip or knee replacement
- Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
NOACs work in a different way to warfarin and so do not require regular INR monitoring but they still increase the risk of bleeding , risk assessments should be undertaken to reflect this increased risk and recorded in the care plan. For more detailed information please see link to NOAC good practice guideline
» Please click here to read the guidance (Herts Valleys)
In order to minimise the risk of cross-contamination please be aware:
Plastic pots should only be used for liquids and are also SINGLE USE. Pots should NEVER be washed and re-used.
Paper SINGLE USE pots should be used for tablets ONLY and should be discarded after each use.
A plastic spoon should also be regarded as single use and disposed of after each use.
Community pharmacists are not obliged to supply medicine pots for medicines administration. Care homes can order medicine pots from various suppliers (approx £3.78/250 waxed paper pots, £2.39 /80 plastic pots)
A bulk prescription is an order for two or more patients, bearing the name of a school or institution e.g. a care home, in which at least twenty persons normally reside, for the treatment of at least ten of whom a particular doctor is responsible.
A bulk prescription allows care home staff to use the same supply of a medication for all residents who are clinically identified as suitable for the prescribed medication.
To provide guidance for care home staff regarding the covert administration of medicines to adults and older people in care homes.
» Covert Administration of Medicines for Care Homes in West Herts
» Covert Administration of Medicines Policy for Care Homes in East and North Herts
Application of Patches
The interval between patches can vary. Patches should be applied at the frequency determined by the prescriber.
The site of application should be rotated with each application in accordance with the manufacturer’s instructions. The manufacturer may recommend that the same site should be avoided for a certain length of time. This varies from patch to patch. Always check the patient information leaflet.
Patches should not be applied immediately after a person has had a bath or shower, as heat can increase the absorption of some medicines into the bloodstream.
Old patches should be removed, folded in half and safely disposed of, before applying a new patch.
The application of a patch should be recorded on the MAR chart.
The specific location of the patch should also be recorded. This may be on the MAR chart if there is sufficient space or using another template e.g. a body map or a patch chart.
When a patient is transferred between settings, staff should ensure that information around the date, time and site of application, are communicated.
In the first instance consider how essential the medication is and whether alternative formulations (e.g. liquids, patches or sublingual tablets) or medications can be used.
Before a person crushes or opens a medication, a pharmacist should always be consulted to find out if this is possible and this should be approved by the prescriber and documented in patient records.
There are some tablets and capsules that should never be crushed or opened such as enteric coated, modified release preparations, hormone, steroid, antibiotic or chemotherapy (cytotoxic) medicines without appropriate advice from a pharmacist.
Liquid medicines ordered from specials manufacturers are unlicensed and often very expensive. Additional patient monitoring may be required which the pharmacist will advise on.
Tablets and capsules are the most commonly prescribed formulation of medicine. However, some care home residents may have difficulties with swallowing and so cannot use tablets or capsules in their wholesale form. In these circumstances, decisions have to be made about whether the medication needs to be continued or if there is an alternative treatment available.
Download ENHerts CCG guidance here
Methotrexate is a powerful cytotoxic medication and should be treated with great care. At the right dose and with appropriate monitoring, it is safe and effective for use. Methotrexate is a disease-modifying drug and affects how the body’s cells grow and reduce the activity of the immune system. It is therefore important that all care home staff involved in the administering of medicines or the handling of body fluids are provided with the appropriate training to ensure they are aware of the associated risks.
Methotrexate is used to treat severe psoriasis, rheumatoid arthritis or Crohn’s disease or in larger doses to treat certain types of cancer.
Click here for information on how to order online
Each resident will be issued with a unique Account ID (user ID) which should be saved securely in the
Emollients: new information about
East and North Herts CCG have recently update their emollient formulary and guidance to ensure best use of NHS resources, all the recommended products are < £5/500g . For residents that have long term conditions that requires regular application of an emollients. Refer to updated guidance.
Epimax® paraffin-Free added as an option following a risk assessment – consider if fire risk is a significant issue e.g. patient prescribed oxygen
The recommended expiry date is 3 months for all products – if this is resulting in waste please ask the GP to review pack size prescribed.
Warnings about the risk of severe and fatal burns are being extended to all paraffin-based emollients regardless of paraffin concentration. Data suggest there is also a risk for paraffin-free emollients.
What is NOAC?
These are a group of novel anticoagulants which helps reduce the risk of clots in a number of indications, see below for further information. These are an alternative to warfarin and NOACs include – apixaban, edoxaban,
- Atrial Fibrillation (AF)
- Recent hip or knee replacement
- Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
Step 1: Care Home Placement
medication should be requested from the hospital on transfer to ensure a MAR sheet is prepared.
Step 2: Care Home Transfer Arrangements
Prior to arranging
Step 3: Care Home Register with New GP
Falls and fall-related injuries are a common and serious problem for older people. People aged 65 and older have the highest risk
of falling, with 30% of people older than 65 and 50% of people older than 80
Residents who have fallen are at high risk of a repeat fall.
Download a list of medications that can contribute to an
Download a list of medications that can contribute to an increased risk of falls (HVCCG)
The recording of drug sensitivity/allergy is important to avoid the inadvertent prescribing, dispensing and administration of an offending drug to the resident. Care home residents are a frail and vulnerable population who are at high risk of adverse drug reactions. There are large discrepancies between drug allergy records, residents care home records, medicines administration record charts and GP medical records. Furthermore, there is no routine system in place for people to keep a record of their own drug
Read full ENHerts CCG guidance here