Medication

Introduction

Utilise the HCPA Medication page for Care Homes and Community Services in Hertfordshire. These resources and guidance have been sourced in conjunction with local specialists and national guidance.

Medicines guidance for HVCCG and EN Herts Care Homes

» Herts Valley Website
» EN Herts website

Contact information:

• Herts Valley CCG
  Email: hvccg.pmot1@nhs.net
  Phone: 01442 898888
• For the latest Care Home newsletters click here
• EN Herts CCG
  Email: enhertsccg.pmot@nhs.net

 

National Guidance – Care Home

Title	Info	Link
National Institute for Health and Care Excellence (NICE) guideline: Managing medicines in care homes	NICE published this guideline in March 2014; it considers all aspects of managing medicines in care homes and recommends that all care home providers have a medicines policy that includes written processes. The policy should ensure that processes are in place for safe and effective use of medicines in the care home.	NICE Guideline SC1: Managing medicines in care homes NICE Guideline SC1: Tools and Resources
National Institute for Health and Care Excellence (NICE): Checklist for care home medicines policy	NICE have produced a checklist for health and social care staff on developing and updating care home medicines policies. It gives more information about the processes that should be covered.	Click here
CQC Medicines: information for adult and social services	Information provided by the CQC on different medication regarding high-risk medications, storage, oxygen, administering and much more.	Click here
Medicines PIL	All recent updates of medication in one place.	Click here
National care forum meds safety resources	Free resources for supporting the safe use of medications in care facilities.	Click here
Care Homes use of Medicines (CHUMS)	Study: Medication errors in nursing & residential care homes ‐ prevalence, consequences, causes and solutions. Report to the Patient Safety Research Portfolio, Dept of Health.	Click here
CQC document – Medicines in Health and Adult Social Care	We know that people’s physical and mental health outcomes improve when medicines are used in the best or optimal way. When they are not prescribed or administered correctly they can cause harm.	Click here

 

National Guidance – Community Services

Title	Info	Link
National Institute for Health and Care Excellence (NICE) guideline: Managing medicines for adults receiving social care in the community	This guideline covers medicines support for adults (aged 18 and over) who are receiving social care in the community. It aims to ensure that people who receive social care are supported to take and look after their medicines effectively and safely at home. It gives advice on assessing if people need help with managing their medicines, who should provide medicines support and how health and social care staff should work together.	NICE Guideline NG67: Managing medicines for adults receiving social care in the community NICE Guideline SC1: Quality StandardNICE Guideline SC1: Tools and Resources
Care Quality Commission (CQC) learning from safety incidents: Issue 5: Safe management of medicines	The ‘Learning from safety incidents’ resources have been developed to share common critical issues identified from CQC’s criminal prosecution work against providers that have failed to provide care and treatment in a safe way. The ‘safe management of medicines’ resource includes prescribing, handling and administering medicines.	Click here
CQC Medicines: information for adult and social services	Information provided by the CQC on different medication regarding high-risk medications, storage, oxygen, administering and much more.	Medicines Information Adult Social Care Services Administering medicines in home care agencies
Medicines PIL	All recent updates of medication in one place.	Click here
National Care Forum meds safety resources	Free resources for supporting the safe use of medications in care facilities.	Click here

 

HCC Medication Domiciliary Care Policy

This document outlines the roles, responsibilities and procedures for assisting people living in their own homes in receipt of regulated and non regulated homecare and community support with prescribed medications as part of their care and support plan. It sets out the procedure from handling and administering medicines, and for their safe storage and disposal. It also outlines what documents should be used and how records should be kept.

» View the full policy here

 

Education and Competencies

Please visit HCPA’s training page to see what medication training HCPA and the County Council are delivering, you will also find information on how you can claim mandatory funding for medication training at your service.

Click here to view HCPA’s Training Page

Although, HCPA does not endorse e-learning as quality training (click here for the Hertfordshire Blended E-Learning Policy). We have been advised of the below medication e-learning from PrescQIPP which you could use to enhance face-to-face training.

PrescQIPP

The Hertfordshire clinical Commissioning groups have funded the use of PrescQIPP E-learning package for Care Home staff across the County. As you will be aware E-Leaning is not considered good enough by itself and should be accompanied with Face to face training and monitoring of competencies to form a Blended Learning Package.

Medication E-Learning available for free via PresQUIPP

» PresQUIPP – Medicines use in care homes: E-Learning course 1-3
» PrescQIPP – Managing medicines for adults receiving social care in the community: E-Learning course
» Guide to log in to PresQuipp if you are a Care Home
» Visit e-learning website here

Medicines Use in Care Homes Course e-learning	Medicines Use in Care Homes: Course 2 e-learning pdf
The Care Homes 1 e-learning package is aimed at all care home staff involved with managing medicines. It is the first of several-planned e-learning packages for Care homes and will include the following modules in addition to three case studies to help apply learning to practice.	The Care Homes -2 e-learning package builds on the content covered in the Medicines use in care homes: Course 1 and includes 7 modules focusing on key topics, in addition to three case studies that will help apply learning to practice
> Module 1 – Welcome and introduction	> Module 1 – Welcome and introduction
> Module 2 – The role of CQC and the NICE guideline and quality standards	> Module 2 – Refused and omitted doses
> Module 3 – The management of medicines in care homes	> Module 3 – Covert administration
> Module 4 – Management of self-medicating residents	> Module 4 – Managing controlled drugs
> Module 5 – Administration of inhalers	> Module 5 – Bulk prescribing
> Module 6 – The management of medicines in care homes	> Module 6 – Homely remedies
> Module 7 – Administration of transdermal patches	> Module 7 – Medicines waste reduction.
> Module 8 – Administration of topical products
> Module 9 Administration of PRN medicines
Further information about the course and how to access the course is included in the flyer here.	Further information about the course and how to access the course is included in the flyer here.

Oral Nutritional Supplements- All Settings

Local guidance

Subject	Description	Links
Adult sip feeds (ONS) in primary care	A quick reference for health and care professionals (including care home staff) regarding identification and treatment of malnutrition in the community. It contains links to all other ‘food first’ documents on the CCG website, in addition to essential guidance on when it is (and is not) appropriate to prescribe ONS and the most cost effective ONS to prescribe. Malnutrition should be identified using the Malnutrition Universal Screening Tool (MUST) before treatment is commenced (medium or high risk = malnourished) Treatment of malnutrition should start with a ‘food first’ approach using the resources below	View the Managing Malnutrition Pathway
Food First – Eating well for small appetites	A self-explanatory leaflet designed for patients at medium or high risk of malnutrition according to MUST. It focuses on enabling patients to increase their nutritional intake by at least 500 calories per day and can be given out by any healthcare professional without additional explanation	View Guidance
Food First – Quick guide	A short version of the above leaflet. It demonstrates how an additional 500 calories can be consumed simply by making 3 or 4 small dietary changes each day	View guidance
Food First – Homemade supplements	Designed for patients at high risk of malnutrition according to MUST and should be provided together with ‘Food first – Eating well for small appetites’. It is equally suitable to be used for patients living in their own homes or in care homes	View guidance
Eating and drinking at end of life	A self-explanatory leaflet designed for the relatives and carers of people who are reaching the end of their lives. It has been requested by a number of GPs and Dietitians, in order to help reassure carers that loss of appetite and reduction in food intake is a normal and expected part of the dying process and that prescribed nutritional products are unlikely to be appropriate at this stage.	View guidance

Food First

Fortifying food is a brief practical guide for Care Home cooks/chefs on how to fortify food for residents at medium or high risk of malnutrition according to MUST. It guides cooks/chefs to use fortifiers which contain more than just fat, and to use an adequate amount of each fortifier so that this counts towards intake of an additional 500 calories per day. For more details about fortifying food click here

 

Ways to adapt the recipe			Energy Kcal (calories)
Food	1 Portion	Adapt by:	Before	After
Milk	1 pint	Add 4 heaped tablespoons dried skimmed milk powder (DSM) to 1 pint whole milk	375	774 (106% extra)
Custard	Large ladle (125mls)	Add 1 heaped tablespoon DSM powder & 2 tablespoons double cream to custard made with whole milk	140	340 (143% extra)
Soup	Large ladle (125mls)	Add 1 heaped tablespoon DSM powder & 2 tablespoons double cream	80	280 (250% extra)
Porridge	Large ladle (125mls)	Add 1 heaped tablespoon DSM powder & 2 tablespoons of double cream to porridge made with whole milk	170	370 (118% extra)
Mashed Potato	1 scoop	Add an extra heaped teaspoon of margarine / butter and tablespoon of cream to mashed potatoes	70	190 (170% extra)
Vegetables	2 Tablespoons	Add 1 heaped teaspoon of margarine / butter to vegetables. Allow to melt.	15	85 (460% extra)
Ice Cream	1 Small Scoop	Pour 2 tablespoons of double cream over ice cream	100	200 (100% extra)
Sponge Pudding	2 Tablespoons	Place an extra 2 teaspoons of jam or syrup on the sponge when serving. Serve with a high calorie custard or ice cream	340	540 (58% extra)
Breakfast Cereal	Small serving (25g)	Use fortified milk with 2 tablespoons of double cream and 2 teaspoons of sugar	200	430 (115% extra)
Milk Pudding	Large ladle (125mls)	Add 1 heaped teaspoon DSM powder & 2 tablespoons double cream to the milk pudding made with whole milk. Serve with 2 teaspoons jam	200	500 (150% extra)

Reducing antipsychotic use for non-cognitive symptoms in dementia

This Herts Valleys CCG document aims to provide a local and practical approach to the treatment of non-cognitive symptoms in dementia, including guidance on de-prescribing of antipsychotics. It includes:

• Guidance for prescribers
• A suggested tapering protocol when reducing and stopping antipsychotics
• Practical tips on dose reduction
• Guidance for care practitioners
• Common side effects of antipsychotic
• Practical guidance and ideas to support a person with non-cognitive symptoms in dementia

 
The guidance has been circulated to GPs across Herts Valleys CCG.

Administration and Records

Administration in Care Homes

Many authorised care home staff can quickly, safely and securely order their resident’s medications online. This saves the care home, pharmacy and GP practice staff time. It also makes the dispensing of individual medicines easier and creates an automatic audit trail.

To help, the Local Government Association and NHS have published a step-by-step guide. It takes care homes through setting up and granting authorised care home staff proxy access to their resident’s GP online services account.

Administering from Original Packaging

Watch below NHS Herts Valley’s CCG Alison Canning talk about Care Home Guidance for Administering from Original Packs.

» Download the supporting Powerpoint presentation
» Download the supporting document

Medication Administration Record (MAR)

Effective record keeping helps ensure that citizens and individuals are always receiving the best possible care and allows for mistakes and concerns to be addressed quickly. Medication Administration Records (MAR) are vital to ensuring staff understand patient’s medical needs and are able to administer the correct medications safely.

Paper based or electronic medicines administration records should:

• Be legible
• Be signed by the care home staff or care workers
• Be clear and accurate
• Have the correct date and time (either the exact time or the time of day the medicine was taken)
• Be completed as soon as possible after the person has taken the medicine
• Avoid jargon and abbreviations

 

» CQC what good looks like for digital records in adult social care
» CQC Guidance about MARs

 

Reducing harm from omitted delayed medicines

Herts and West Essex ICB have recently produced a guidance document on reducing harm from omitted and delayed medicines in care homes.

The guidance includes:

• Actions to take following a missed dose.
• Common reasons for missed doses and suggested actions.
• Dealing with errors/incidents.
• Good practice recommendations to prevent missed doses.

Click here for the full document

Bulk Prescribing in Care Homes

Herts Valley Guidance

Bulk Prescribing Guidance for Care Homes	Click here
Bulk Prescribing Order Form (Appendix 1)	Click here
Care Home Sign in Sheet for Bulk Prescribed Medication (Appendix 2)	Click here

 

East and North Herts Guidance

Bulk Prescribing Full Guidance for Care Homes	Click here
Bulk Prescribing Quick Guide for Care Homes	Click here
SOP for Delivering Bulk Prescribing in Care Homes (GP Practice)	Click here

 

Webinars

Anticipatory Medication and Bulk Prescribing in Care Homes – Webinar recording 29.04.20	Click here
Anticipatory Medication and Bulk Prescribing in Care Homes – Webinar Slides 29.04.20	Click here

 

Anticoagulants and Head Injuries

CQC have identified that there have been incidents where people who are taking anticoagulants have fallen and hit their heads. The increased risks of their medication has not been considered, and therefore medical assistance has not been sourced.

The Clinical Medical Journey (2019) provides evidence that medical support should be provided to those who are increasingly old, frail, and comorbid. Frail older patients who sustain head injury from a fall and are prone to haemorrhagic complications because of anticoagulants.

NICE has created guidance on what information should be included in a care plan to support the use of anticoagulants. This includes:

• How to use anticoagulants
• How long to take anticoagulant treatment
• Possible side effects of anticoagulant treatment and what to do if these occur
• The effects of other medications, foods and alcohol on oral anticoagulation treatment
• How to monitor their anticoagulant treatment
• How anticoagulants may affect their dental treatment
• What to do if they are planning pregnancy or become pregnant
• How anticoagulants may affect activities such as sports and travel
• When and how to seek medical help

This information should also be included in the individuals falls risk assessment.

To ensure safety of those you support Healthcare Professionals must ensure that CT head scans are performed within 8 hours of a head injury in people who are taking anticoagulants and no other risk factor of brain injury.

» Click here for the CQC guidance on anticoagulants
» Click here for the NICE guidance on CT head scans for people taking anticoagulants
» Click here for the Herts and West Essex ICB anticoagulants good practice guidance 

Safety needles

In line with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 and as agreed at February 2020 Hertfordshire Medicines Management Committee where a safety needle is required by a healthcare worker, this should be provided by the health care workers’ employer. Therefore, healthcare organisations should ensure that they have processes in place to source safety needles for use by their employees. This was due to be published earlier but has been on hold at the request of providers due to COVID pressures.

We appreciate many of you will already have the appropriate system in place, but we hope to provide sufficient notice to allow for the healthcare organisations to purchase safer sharps and distribute to their employees who may be involved in administering insulin and injectable therapies to patients. Therefore, we will be publishing the guidance on 1st May 2022 to allow adequate time for implementation by healthcare organisations.

Implication

• Therefore, if a nurse (e.g. district nurse / nursing home) is injecting the insulin they would be expected to bring their own safety needles.
• From 1st May the Trust who employ community nurses will provide the safety needles that they require to keep them safe. Care homes will no longer need to request them from GPs and GPs will be advised not to prescribe.

In line with this we will be updating local guidelines as below.

Safety needles:

• Safety needles should NOT be prescribed on FP10 for use by healthcare professionals and employees; it is the employer’s responsibility to provide them.^1,2

• Safety needles which incorporate automatic safety locks should be used by all healthcare professionals and by all employees in the healthcare sector when administering insulin to patients.
• Safety needles CAN be prescribed on FP10 for use for patients whose insulin is administered by a non-professional healthcare worker, e.g. carer

References:

• NHSE: Items which should not be routinely prescribed in primary care: Guidance for CCGs. Version 2, June 2019.
• Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. Guidance for employers and employees: http://www.hse.gov.uk/pubns/hsis7.pdf

Click here for information on prescribing of needles for pre-filled and reusable insulin pens

Covert Administration in Care Homes

Herts Valley Guidance

• Covert Administration of Medication Policy for Care Homes
• Covert Administration of Medication Policy for Care Homes: Appendix 1 – Medication Risk Assessment Form

East and North Herts

• Covert Medication Care Home Guidelines

Crushing Tablets/ Opening Capsules in Care Homes

Herts Valley Guidance

• Guidance on crushing tablets or opening capsules in a care home setting v2.0 – February 2020
• Medication Risk Assessment for Residents with Swallowing Difficulties (Appendix 1)

East and North Herts

• GPG Crushing

Homely Remedies and Self-Care/ Over the Counter (OTC) in care homes

CQC National Guidance for over the counter Medication and Homely Remedies	Click here
Herts Valley Guidance – Homely Remedies Guidance for Care Homes	Click here
Herts Valley Guidance: Appendix 2 – Homely Remedy Authorisation Form	Click here
Herts Valley Guidance – Homely Remedies Guidance: Appendix 2 – Homely Remedy Stock Control Record Sheet	Click here
Herts Valley Guidance: Appendix 4 – Homely Remedy Staff Signature Sheet	Click here
Herts Valley Guidance – Prescribing Over-The-Counter Medication to individuals in receipt of Social Care	Click here
East and North Hertfordshire – Over-the-Counter medicines resources	Click here
East and North Hertfordshire – Self Care Toolkit for Care Homes	Click here
East and North Hertfordshire – Homely Remedies Guidance for Care Homes	Click here
Homely Remedies Webinar – Slides from the webinar delivered on 14.09.20	Click here
Homely Remedies Webinar – Recording of webinar delivered on 14.09.21	Click here

 

Ordering and Waste Reduction in Care Homes

Medication Ordering Cycle

This updated good practice guidance, produced by the Herts Valleys CCG and East & North Herts CCG care home pharmacy teams, covers the key stages involved in a 28 day medication cycle, providing a framework for care home staff, community pharmacies and GP practices to ensure a safe and efficient process for the ordering, prescribing and supply of medicines. The document also includes a template communication sheet, which can be used by care home staff to notify their community pharmacy about mid-cycle and acute prescriptions.

Refer to the Herts Valleys CCG website and East & North Herts CCG website for the full range of medicines guidance documents available for care home staff.

Reducing medicines waste

The care home pharmacy team at Herts Valleys CCG, and East and North Herts CCG, have developed guidance on reducing medicines waste in care homes. The guidance contains key top tips to support care home staff and prescribers to reduce unnecessary medicines waste in care homes, and also includes expiry date guidelines for care home staff. It is important that there are effective systems and processes in place to ensure that medicines are managed appropriately to reduce avoidable medicines waste, and therefore to allow effective use of NHS resources.

The guidance can be found via the following link for CCG guidance. Many factors can contribute to medicines waste in care homes, and a joint effort involving the care homes, community pharmacies and GP practices required. The guidance has been sent to all GP practices and community pharmacies within Herts Valleys CCG. Please share this guidance with all relevant staff within your care home.

» For information on the medication, ordering cycle click here.
» Watch the Bohemian Polypharmacy music video

Useful Resources

Herts Valley CCG – Medication Ordering Cycle for Care Homes	Click here
Herts Valley CCG – Medication Ordering Cycle for Care Homes: Appendix 1 – Communication template	Click here
East and North Herts CCG – Carrying Medication Forward in Care Homes	Click here
East and North Herts CCG – Reducing Medicines Waste in Care Homes	Click here
East and North Herts CCG – Setting up Online Ordering of Medication	Click here
East and North Herts CCG – Proxy Access Request and Removal of Access Set Up Form	Click here
East and North Herts CCG – Care Home and GP SOP Proxy Access Consent Form	Click here
East and North Herts CCG – Proxy Access Consent Form	Click here
East and North Herts CCG – TPP SYSTMOne User guide for Ordering Medication online by Proxy Access	Click here
East and North Herts CCG – Questions and Answers for Care Homes	Click here
Waste Reduction in Care Homes – Webinar 02.09.20	Click here
Waste Reduction in Care Homes – Webinar Slides 02.09.20	Click here

 

PRN (When Required) Medication in Care Homes

• Herts Valley CCG – ‘When Required’ Medication (PRN) Good Practice Guidance for Care Homes v1.0 – February 2020
• Herts Valley CCG – When Required PRN/Variable Dose Template (Appendix 1)
• East and North Herts CCG – ‘When required’ PRN Medication

Reviews in Care Homes

A medication review is a chance for your GP (doctor) and a specialist pharmacist to take a detailed look at the medicines that you are taking, to make sure that they are working well for you and are not giving you any problems. Medication reviews are particularly useful for people who take lots of medicines as they can be at greater risk of having a bad reaction and needing to be admitted to hospital.

Also, as you get older, some of the medicines you have been taking for a while might become less important. For example, if you are over 80 you might not be too concerned about reducing your risk of a heart attack in twenty years’ time and you might not want to have muscle aches, constipation and poor sleep which are potential side effects of statins ‐ common cholesterol lowering drugs.

» Herts Valley CCG – Top Tips for Care Homes Medication Reviews

Deprescribing

• The number of medicines patients are taking is increasing, driven by the ageing population, multiple prescribers and evidence-based guidelines (usually based on single conditions).
• For many patients, the potential harms of multiple medicines outweigh the potential benefits, reducing life expectancy and quality of life.
• Older people and those with increasing frailty are frequently prescribed unnecessary, or higher risk medicines, they should have more frequent medication reviews.
• Deprescribing is the planned process of reducing or stopping medications that may no longer be of benefit or may be causing harm.
• The goal is to reduce medication burden or harm while improving quality of life, thus ensuring appropriate polypharmacy and improving patient outcomes.

What happens during a medication review?

Your GP and pharmacist will look at the medicines you take.

They will consider whether:

• there has been a change in your health or the guidelines on how to treat your condition
• you are able to take your medicines without difficulties
• you are taking any unnecessary medicines
• there is a different medicine which will be just as effective but cheaper for the NHS

Your GP and pharmacist will look at the medicines you take.

What happens next:

Once the team has reviewed your medicines, any changes that are needed will be made slowly and gradually. We will make sure you are told about which medicines are being changed and can answer any questions you may have.

Changes might be:

• How often you take medicines – for example, taking a tablet once a day rather than three times a day.
• You might start a new medicine or change to a different version.
• A medicine being stopped because you no longer need it.

»Download the medication review leaflet here.

To find out more please contact your local CCG Team

Reporting medication errors

Hertfordshire adult safeguarding board have produced new guidance and there are now two ways to report medication errors.

-All medication errors need to be reported

Errors that do NOT trigger a safeguarding notification need to be reported using the form here.

-All errors that raise a safeguarding concern are still reported by raising a safeguarding concern with Hertfordshire County Council.

Click here to report a concern about an adult

Click here to view the full guidance which includes details of what errors trigger a safeguarding concern.

 

The 8 Rights of Medication Administration

One of the recommendations to reduce medication errors and harm is to use the “eight rights” The rights of medications administration are there not only to reduce the harm caused by medications errors but also to protect the interests of the patient and the person administering the medication.

» Click here for full information on the 8 rights

 

Further Guidance

Patches

Different types of medicines are available in patch form; some include painkillers, medicines to treat Parkinson’s disease, and medicines to control nausea and vomiting.

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.

Record keeping of Patches

• 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.

 

Allergies

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 sensitivities / allergies. This can lead to confusion over which drugs can be taken safely and can result in residents inadvertently taking a drug they are allergic to.t settings. You can also style every aspect of this content in the module Design settings and even apply custom CSS to this text in the module Advanced settings.

» Read full EN Herts CCG guidance here
» Read full HVCCG guidance here

Emollients: new information about risk of severe and fatal burns with paraffin-containing and paraffin-free emollients

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.

» View further information

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.

Other Useful Resources

East and North Herts CCG  – Managing acute and urgent prescriptions in Care Homes	Click here
East and North Herts CCG – Managing interim prescriptions (non-urgent, mid cycle requests) in Care Home	Click here
East and North Herts CCG – GPG CAS Alerts	Click here
East and North Herts CCG – Medicines on transfer into Care Home	Click here
East and North Herts CCG – List of medications that can contribute to an increased risk of falls	Click here
East and North Herts CCG – Safe Handling of High Risk Medicines	Click here
Herts Valley CCG – List of medications that can contribute to an increased risk of falls	Click here
Herts Valley CCG Guidance on recording, maintaining and sharing drug sensitivity/allergy information in care homes	Click here
Medicine pots IPC poster	Click here

 

Vitamin D

In 2016 Public Health England issued guidance that population groups at increased risk of vitamin D deficiency (such as people who are confined indoors, including those in care homes) should take a daily 10 micrograms/400 units vitamin D supplement throughout the year.

In early 2021, in response to the global pandemic, the Department of Health and Social Care made the decision to provide a free 4 month supply of vitamin D to all care home residents.

At the same time, the Care Quality Commission made it clear that care homes “should consider how to support people to continue to take vitamin D when the free supplies end.” because “Care home providers are required to meet resident’s full nutritional needs to sustain life and good health, and reduce the risks of malnutrition, in line with regulation 14 (Part A) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition to provision of nutritious meals, this includes food supplements where necessary, such as vitamin D.”

GPs should not prescribe 10 microgram (400 IU) doses of Vitamin D now the free supply has ended care homes are responsible for providing this to residents. The position statements can be read here for ENCCG and here for HVCCG

Whilst most people get the Vitamin D they need from sunlight, many are serious risk of having a deficiency. Vitamin D is incredibly important for bone health.

Useful Resources

CQC – Vitamin D Supplements supporting people who receive adult social care	Click here
NHS –  Vitamin D Easy Read	Click here
East and North Herts CCG – Vitamin D FAQ	Click here
Herts Valley CCG –  West Herts FAQ	Click here
GOV.UK – Vitamin D and care home guidance	Click here