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Managing medicines for people receiving social care in the community

About

What is covered

This interactive flowchart covers managing medicines for adults (aged 18 and over) who receive social care support in the community. It aims to improve processes and care to ensure that people's medicines are taken and looked after correctly and safely. It gives clear advice on what support should be provided by whom, how health and social care staff should work together to provide care, and how to manage concerns about medicines.
The recommendations in this interactive flowchart assume that the responsibilities for providing medicines support have been agreed between the relevant NHS and local authority commissioners. The recommendations aim to ensure that medicines are managed safely and effectively for all adults receiving social care in the community. People living in residential or nursing care homes are covered by NICE's recommendations on managing medicines in care homes.
Before any medicines support is provided by a social care provider, commissioning and contractual arrangements need to be discussed, agreed and recorded as part of the local care planning process. This is to ensure that it is clear who is responsible and accountable for the decisions being made, and which providers will deliver each aspect of medicines support.

Updates

Updates to this interactive flowchart

23 July 2018 Medicines management for people receiving social care in the community (NICE quality standard 171) added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on policies and processes for managing medicines for people receiving social care in the community in an interactive flowchart

What is covered

This interactive flowchart covers managing medicines for adults (aged 18 and over) who receive social care support in the community. It aims to improve processes and care to ensure that people's medicines are taken and looked after correctly and safely. It gives clear advice on what support should be provided by whom, how health and social care staff should work together to provide care, and how to manage concerns about medicines.
The recommendations in this interactive flowchart assume that the responsibilities for providing medicines support have been agreed between the relevant NHS and local authority commissioners. The recommendations aim to ensure that medicines are managed safely and effectively for all adults receiving social care in the community. People living in residential or nursing care homes are covered by NICE's recommendations on managing medicines in care homes.
Before any medicines support is provided by a social care provider, commissioning and contractual arrangements need to be discussed, agreed and recorded as part of the local care planning process. This is to ensure that it is clear who is responsible and accountable for the decisions being made, and which providers will deliver each aspect of medicines support.

Updates

Updates to this interactive flowchart

23 July 2018 Medicines management for people receiving social care in the community (NICE quality standard 171) added.

Sources

NICE guidance and other sources used to create this interactive flowchart.

Quality standards

Medicines management for people receiving social care in the community

These quality statements are taken from the medicines management for people receiving social care in the community quality standard. The quality standard defines clinical best practice for medicines management for people receiving social care in the community and should be read in full.

Quality statements

Assessing medicines support needs

This quality statement is taken from the medicines management for people receiving social care in the community quality standard. The quality standard defines clinical best practice for medicines management for people receiving social care in the community and should be read in full.

Quality statement

Adults having an assessment for social care in the community have their medicines support needs included in the assessment.

Rationale

People’s medicines support needs should be assessed as part of an overall assessment of needs and preferences for social care in the community, and then as needed. This helps people and their families or carers to share their aims and goals for how they manage their medicines. It also allows them to agree any support needed from services to take medicines safely and effectively.

Quality measures

Structure
Evidence that assessments of an adult’s needs and preferences for social care in the community include assessment of their medicines support needs.
Data source: Local data collection, for example from assessment forms.
Process
Proportion of adults having an assessment for social care in the community who have their medicines support needs included in the assessment.
Numerator – the number in the denominator who have their medicines support needs included in the assessment.
Denominator – the number of adults having an assessment for social care in the community.
Data source: Local data collection, for example audit of assessments for social care in the community.
Outcome
Satisfaction of people receiving social care in the community that their medicines support meets their needs and preferences.
Data source: Local data collection, for example service user and carer satisfaction surveys.

What the quality statement means for different audiences

Service providers (services assessing social care needs) ensure that procedures for assessing an adult’s needs and preferences for social care in the community include an assessment of medicines support needs. Assessments of medicines support needs are then carried out as needed. Staff who assess medicines support needs are trained and have the necessary knowledge, skills and experience.
Commissioners (local authorities) ensure that services responsible for assessing people’s need for social care in the community have systems in place to assess people’s medicines support needs as part of the needs and preferences for social care in the community, and then as needed.
Adults being assessed for social care support at home (and their families or carers, if appropriate) are asked about any medicines they are taking and whether they need help to use or look after them. This is checked again at an agreed time to make sure they have the support they need.

Source guidance

Managing medicines for adults receiving social care in the community (2017) NICE guideline NG67, recommendation 1.2.1

Definitions of terms used in this quality statement

Medicines
All prescription and non-prescription (over-the-counter) healthcare treatments, such as oral medicines, topical medicines, inhaled products, injections, wound care products, appliances and vaccines.
Medicines support needs
Medicines support needs should focus on how the person can be supported to manage their own medicines, taking into account:
  • the person's needs and preferences, including their social, cultural, emotional, religious and spiritual needs
  • the person's expectations for confidentiality and advance care planning
  • the person's understanding of why they are taking their medicines
  • what they are able to do and what support is needed, for example, reading medicine labels, using inhalers or applying creams
  • how they currently manage their medicines, for example, how they order, store and take their medicines
  • whether they have any problems taking their medicines, particularly if they are taking multiple medicines
  • whether they have nutritional and hydration needs, including the need for nutritional supplements or parenteral nutrition
  • who to contact about their medicines (ideally the person themselves, if they choose to and are able to, or a family member, carer or care coordinator)
  • the time and resources likely to be needed.
Family members and carers should be included in the process, if this has been agreed with the person who is having their needs assessed.
[NICE’s guideline on managing medicines for adults receiving social care in the community, recommendations 1.2.4 and 1.2.5]

Equality and diversity considerations

If a person has a learning disability, cognitive decline or fluctuating mental capacity, services providing medicines support should make reasonable adjustments to ensure that the person and their family members or carers are actively involved in discussions and decision making. The person's views and preferences should be recorded to help make decisions in the person's best interest if they lack capacity to make decisions now or in the future.

Communicating that medicines support has started

This quality statement is taken from the medicines management for people receiving social care in the community quality standard. The quality standard defines clinical best practice for medicines management for people receiving social care in the community and should be read in full.

Quality statement

Adults receiving medicines support in the community from a social care provider have their general practice and supplying pharmacy informed that support has started.

Rationale

Knowing who is responsible for providing medicines support and who to contact allows prescribers to communicate any changes to medicines to the relevant person. This helps to ensure that all services involved in medicines support can share information about any changes to medicines or medicines support needs, and that people receive the support they need to take their medicines safely and effectively.

Quality measures

Structure
Evidence of local arrangements for social care providers to notify a person’s general practice and supplying pharmacy when they start to provide them with medicines support in the community.
Data source: Local data collection, for example a documented medicines policy.
Process
a) Proportion of adults receiving medicines support in the community from a social care provider whose general practice is informed that medicines support has started.
Numerator – the number in the denominator whose general practice is informed that they have started to receive medicines support.
Denominator – the number of adults receiving medicines support in the community from a social care provider.
Data source: Local data collection, for example audit of records of adults receiving medicines support in the community from a social care provider.
b) Proportion of adults receiving medicines support in the community from a social care provider whose supplying pharmacy is informed that medicines support has started.
Numerator – the number in the denominator whose supplying pharmacy is informed that they have started to receive medicines support.
Denominator – the number of adults receiving medicines support in the community from a social care provider.
Data source: Local data collection, for example audit of records of adults receiving medicines support in the community from a social care provider.
Outcome
Number of medicines-related incidents.
Data source: Local data collection, for example audit of incident reporting and service user complaints from adults receiving medicines support in the community from a social care provider.

What the quality statement means for different audiences

Service providers (social care providers) have procedures in place to inform the person’s general practice and supplying pharmacy when they start to provide medicines support to an adult receiving social care in the community.
Registered managers of services providing medicines support to adults receiving social care in the community inform the person’s general practice and supplying pharmacy when they start to provide them with medicines support.
Healthcare professionals (prescribers and supplying pharmacies) record when an adult receiving social care in the community is starting medicines support, and make a note of who to contact about any changes to medicines.
Commissioners (local authorities) ensure that they commission services that inform the person’s general practice and supplying pharmacy when adults receiving social care in the community start to have medicines support.
Adults receiving social care at home have their general practice and supplying pharmacy told if they start having help with their medicines. This means that their GP and pharmacist know who to contact if there are any changes to the person’s medicines or to their support needs.

Source guidance

Managing medicines for adults receiving social care in the community (2017) NICE guideline NG67, recommendations 1.3.1 and 1.3.2

Definitions of terms used in this quality statement

Medicines
All prescription and non-prescription (over-the-counter) healthcare treatments, such as oral medicines, topical medicines, inhaled products, injections, wound care products, appliances and vaccines.
Social care provider
A provider organisation, registered with the Care Quality Commission to provide community adult care services, that directly employs care workers to provide personal care and support in a person's home.

Recording medicine support needs

This quality statement is taken from the medicines management for people receiving social care in the community quality standard. The quality standard defines clinical best practice for medicines management for people receiving social care in the community and should be read in full.

Quality statement

Adults receiving medicines support in the community from a social care provider have a record of the medicines support that they need in their care plan.

Rationale

Medicines use can be complex, particularly when people have several long-term conditions and are taking multiple medicines. It is important that people taking and administering medicines have an accurate record of the medicines support needed. This includes information about what support is needed, how it should be provided and who can provide the support. This can help to make sure that medicines are taken safely and effectively and enables people to manage their medicines.

Quality measures

Structure
Evidence of local processes for social care providers to ensure that care plans include a record of the medicines support a person needs.
Data source: Local data collection, for example an audit of local processes.
Process
Proportion of adults receiving medicines support in the community from a social care provider whose care plan includes a record of the medicines support they need.
Numerator – the number in the denominator that include a record of the medicines support they need.
Denominator – the number of care plans for adults receiving medicines support in the community from a social care provider.
Data source: Local data collection, for example an audit of care plans for adults receiving medicines support in the community from a social care provider.
Outcome
a) Satisfaction of people providing medicines support with information recorded about the medicine support needed.
Data source: Local data collection, for example staff surveys.
b) Satisfaction of people receiving social care in the community with their medicines support.
Data source: Local data collection, for example service user and carer satisfaction surveys.

What the quality statement means for different audiences

Service providers (social care providers) have robust processes for ensuring that a person’s medicines support needs are recorded in their care plan following assessment. The record of support needs should include the person’s preferences and their expectations for confidentiality.
Commissioners (local authorities and clinical commissioning groups) ensure that they commission services that follow robust processes for ensuring that care plans include a record of the medicines support needed by a person.
Adults receiving social care at home that includes help with their medicines have information about the way they would like to be supported to take their medicines written into their care plan, so that they get the help they need to take them correctly.

Source guidance

Managing medicines for adults receiving social care in the community (2017) NICE guideline NG67, recommendations 1.2.5

Definitions of terms used in this quality statement

Medicines
All prescription and non-prescription (over-the-counter) healthcare treatments, such as oral medicines, topical medicines, inhaled products, injections, wound care products, appliances and vaccines.
Record of medicines support needs
If a person needs medicines support, the following information should be included in their care plan:
  • the person's needs and preferences
  • the person's expectations for confidentiality and advance care planning
  • how consent for decisions about medicines will be sought
  • details of who to contact about their medicines (the person or a named contact)
  • what support is needed for each medicine
  • how the medicines support will be given
  • who will be responsible for providing medicines support, particularly when it is agreed that more than one care provider is involved
  • when the medicines support will be reviewed, for example, after 6 weeks.
[NICE’s guideline on managing medicines for adults receiving social care in the community, recommendation 1.2.5]
Social care provider
A provider organisation, registered with the Care Quality Commission to provide community adult care services, that directly employs care workers to provide personal care and support in a person's home.

Equality and diversity considerations

If a person has a learning disability, cognitive decline or fluctuating mental capacity, services providing medicines support should make reasonable adjustments to ensure that the person and their family members or carers are actively involved in discussions and decision making. The person's views and preferences should be recorded to help make decisions in the person's best interest if they lack capacity to make decisions now or in the future.

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Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Care workers should ask the person if they are ready to take their medicine, before removing it from its packaging, unless this has been agreed and it is recorded in the provider's care plan.
When a person declines to take a medicine, care workers should consider waiting a short while before offering it again. They should ask about other factors that may cause the person to decline their medicine, such as being in pain or discomfort (see also safeguarding and supporting people to raise concerns for recommendations on reporting concerns or seeking advice).
Social care providers should ensure that care workers are able to prioritise their visits for people who need support with time-sensitive medicines.

Mental capacity

The ability of a person to make a decision about their own care, including:
  • decisions that affect daily life (for example, when to get up, what to wear or whether to go to the doctor when feeling ill, and more serious or significant decisions)
  • decisions that may have legal consequences, for them or others (for example, agreeing to have medical treatment, buying goods or making a will).
The Mental Capacity Act 2005 defines a lack of mental capacity as when 'a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain'.
Health professionals should follow the Department of Health's advice on consent. If a person does not have capacity to make decisions, health and social care practitioners should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.

Glossary

a voluntary process of discussion about what care a person would or would not want in the future, if they were unable to make decisions because of illness or a lack of mental capacity to consent; the person may also choose to involve their family members or friends in discussions
the term used to define an informal, unpaid carer only (see also care worker)
the term used to define informal, unpaid carers only (see also care workers)
this is when medicines are given in a disguised form without the knowledge or consent of the person receiving them
a person who is employed to provide care and support to people in their own home; this includes home care workers, personal assistants (who are directly employed by people who use services) and other support workers
people employed to provide care and support to people in their own home; this includes home care workers, personal assistants (who are directly employed by people who use services) and other support workers
in health and social care, this enables open and honest reporting of mistakes that are treated as an opportunity to learn to improve care
the wider health and social care team of health professionals and social care practitioners (health professionals include, but are not limited to, GPs, pharmacists, hospital consultants, community nurses, specialist nurses and mental health professionals, and social care practitioners include, but are not limited to, care workers, case managers, care coordinators and social workers. When specific recommendations are made for a particular group, this is specified in the recommendation)
includes all prescription and non-prescription (over-the-counter) healthcare treatments, such as oral medicines, topical medicines, inhaled products, injections, wound care products, appliances and vaccines
includes all prescription and non-prescription (over-the-counter) healthcare treatments, such as oral medicines, topical medicines, inhaled products, injections, wound care products, appliances and vaccines
any support that enables a person to manage their medicines; this varies for different people depending on their specific needs
a system for packing medicines, for example, by putting medicines for each time of day in separate blisters or compartments in a box
systems for packing medicines, for example, by putting medicines for each time of day in separate blisters or compartments in a box
the packaging in which the medicine is supplied by the supplying pharmacy – this could be a manufacturers packaging or pharmacy supplied packaging after larger amounts of medicines have been decanted for individual patient use
providing nutrients intravenously
a written plan that sets out the care and support that providers and the person have agreed will be put in place, following a local authority assessment. It includes details of both personal care and practical support
medicines that needs to be given or taken at a specific time, where a delay in receiving the dose or omission of the dose many lead to serious patient harm, for example, insulin injections for diabetes or specific medicines for Parkinson's disease
a provider organisation, registered with the Care Quality Commission to provide community adult care services, which directly employs care workers to provide personal care and support in a person's home
provider organisations, registered with the Care Quality Commission to provide community adult care services, which directly employs care workers to provide personal care and support in a person's home

Paths in this pathway

Pathway created: March 2017 Last updated: July 2018

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