Care Homes News
Medicines Management Team
Edition: 11 | July 2020
In This Issue:
- Pharmacy and Medicines Support to Care Homes during the pandemic
- COVID-19 – Important guidance links for care homes
- BLMK Medicines Re-use Standard Operating Procedure (SOP)
- Homely Remedies Toolkit and Flowchart – extended
- COVID-19 End of Life (EOL) Medicines Service
- Falls and Medicines
- NHS mail and DSP Toolkit – update
- On-line ordering of medication
Pharmacy and Medicines Support to Care Homes during the pandemic
In response to the pandemic, NHS England and NHS Improvement issued guidance on a new ‘COVID-19 response’ operational model that is intended to help pharmacy teams better support care homes. As a result, members of the Bedfordshire CCG Medicines Optimisation Team (Pharmacists and Pharmacy care home technicians) are now aligned to Primary Care Networks (groups of GP practices) and currently support the care homes affiliated with the Primary Care Networks. We are working collaboratively with community providers, practice pharmacists and our central locality team so that care homes across Central Bedfordshire and Bedford Borough benefit, measures include:
Facilitating medication supply to care homes, including end of life medication
Delivering structured medication reviews – via video or telephone consultation
Supporting reviews of new residents or those recently discharged from hospital
Supporting care homes with medication queries, and facilitating their medicines needs with the wider healthcare system (e.g. through medicines ordering).
If you have any general (non-clinical) medication queries, please contact our care home pharmacy technicians – Sharon Tansley (care homes for the elderly, Central Beds and Learning Disability homes Bedfordshire wide) or Lindsey Ashpole (care homes for the elderly, Bedford Borough)
COVID-19 - Important guidance links for care homes
We understand that these are challenging times for care homes and are conscious that you may be receiving a lot of information from various sources. For this reason we have produced links (below) to a few of the key guidance documents:
Coronovirus (COVID-19): admission and care of people in a care homes
British Geriatric Society – Guidance on managing the Covid-19 pandemic in care homes
COVID-19: infection prevention and control (IPC)
Coronavirus (COVID-19): getting tested
COVID-19: how to work safely in care homes
Coronavirus (COVID-19): looking after people who lack mental capacity
Coronavirus (COVID-19): adult social care action plan
BLMK Medicines Re-use Standard Operating Procedure (SOP)
Due to increasing concerns of the pressure posed on the medicines supply chain during the peak of the COVID-19 pandemic, national recommendations on the re-use of medicines in care homes and hospices in England have been changed. The Department of Health and Social Care (DHSC) have published a Standard Operating Procedure (SOP) guidance for re-use of medicines in a care home and hospice setting during the COVID-19 pandemic.
Bedfordshire, Luton and Milton Keynes CCGs (BLMK CCG) Medicines Optimisation Teams have summarised this guidance (attached) to support implementation should care home providers wish to include re-use of medicines as additional process to ensure timely provision of medicines for their residents. This guidance is based on national and local guidance available at time of publication and is regularly being monitored and updated by the CCG team. Care homes in Central Beds and Bedford Borough that intend to re-use medicines during the pandemic should inform the Bedfordshire CCG Medicines Optimisation teams via this email: BEDCCG.firstname.lastname@example.org
Homely Remedies Toolkit and Flowchart - extended
The current Bedfordshire CCG Homely Remedies Toolkit and Flowchart for use by care homes has been extended until October 2020. This guidance will be reviewed with plans for it to be a Bedfordshire, Luton and Milton Keynes (BLMK) wide guidance document.
In the meantime, the toolkit and flowchart can be found on the Care Home Team page on medicines.blmkccg.
Our team actively encourage care homes to implement the homely remedies scheme. Please be advised that only the list of products included in our current guidance has been approved for use by GPs practices across Bedfordshire CCG
COVID-19 End of Life (EOL) Medicines Service
This is to remind all of our care homes of the COVID-19 End of Life (EOL) medicines service available across Bedfordshire.
The anticipatory medicines list was reviewed in line with national guidance on COVID-19 and includes non-injectable alternatives. The updated Bedfordshire CCG (BCCG) COVID-19 EOL medication list and list of pharmacies stocking EOL medicines can be found on the COVID-19 information page on medicines.blmkccg.
To further support out of hours provision, EOL medicines pre-packs are now stocked at the urgent care centres and all other bases linked to on-call. With this in place, the on call community pharmacy service for EOL across Bedfordshire, Luton and Milton Keynes has been reviewed and stopped.
The East of England have launched a palliative care medicines website: https://pcm.prescqipp.info/ that further supports care homes with access to community pharmacies that stock EOL medications at the time they require and in accordance with location.
To use, simply enter your postcode and click ‘Search’. The map will centre on your location and show pharmacies within a 30 km radius, ordered by their proximity to you
Falls and Medicines
Falls are common in older people, especially those over 65 years and the prevalence increases with age. The risk of falls may be due to a number of factors and therefore prevention is usually based on assessing multiple risk factors. Information on ‘Falls – risk assessment’ can be found on the NICE CKS website: https://cks.nice.org.uk/falls-risk-assessment#!scenarioRecommendation:1
The strongest risk factor would be someone who has a history of falls. Other risk factors for falls in older people include:
Conditions that affects mobility or balance, such as arthritis, diabetes, incontinence, stroke, syncope, or Parkinson’s disease.
Other conditions, including muscle weakness, poor balance, visual impairment, cognitive impairment, depression, and alcohol misuse.
Polypharmacy (use of multiple medicines together), or the use of sedating medicines (such as benzodiazepines or hypnotics) or medicines used to lower blood pressure that can cause a sudden drop in blood pressure when they stand up after sitting or lying down.
Home hazards, such as loose rugs or mats, poor lighting, wet surfaces (especially in the bathroom), and loose fittings (such as handrails).
A multifactorial risk assessment by an appropriately skilled and experienced clinician (usually in a specialist falls service) should be offered to older people who have had one or more falls in the past year or demonstrate abnormalities of gait and/or balance. This may include assessing for home hazards, visual impairment and medication.
Medication is just one possible risk factor that may be contributing to falls. There are numerous medicines that may increase a person’s falls risk. We have attached a poster that categorizes medication as ‘High risk, Medium risk and Low Risk’ of contributing to falls. Polypharmacy can increase falls risk and some underlying illnesses will add to that risk. Medication should be reviewed regularly (at least annually) to assess its need.
If you are concerned that a medicine(s) could be contributing to a resident’s falls, then this should be flagged to the GP/nurse through the multidisciplinary team (MDT) meeting and/or pharmacist. Any decisions regarding medication changes (e.g. stopping medication) would be made following a review by a clinician (e.g. GP, nurse) and/or pharmacist.
Anticoagulants and falls
Anticoagulants are medicines used to prevent and treat blood clots. Examples of anticoagulants include: Warfarin, Non-vitamin K antagonist oral anticoagulants (also known as DOACs or NOACs – this includes apixaban, rivaroxaban, edoxaban and dabigatran) and injectable anticoagulants (also known as low molecular weight heparins). A common side effect of anticoagulants is bleeding.
Anticoagulants do not cause falls but they increase the complications of a fall (e.g. bleeding). If a patient falls, the consequence could be worse if they are on an anticoagulant.
Care staff should be aware of medicines that may cause falls and identify residents who may be at higher risk (especially those who are taking an anticoagulant), and if you have any concerns the resident should be flagged for a medication review.
CQC have produced guidance on ‘High risk medicines: anticoagulants’, please click on the link below should you wish to refer to this.
NHS mail and DSP Toolkit - update
As you may already be aware, Bedfordshire CCG and the Local authorities have been working with residential and nursing homes to set up shared/ generic email addresses as part of a national NHS mail fast track programme in response to Covid-19.
It is expected that email correspondence between care homes and other healthcare organisations e.g. GP surgeries, community health and social service providers, and the acute trusts will be via the care home shared nhs.net email account, rather than solely through individual care home staff nhs.net email accounts.
The care home secure or nhs.net shared mail box will be the primary email account to be used. However it is recommended, particularly in the early stages whilst the new process embeds, that individual care home staff also include their personal nhs.net account address in the ‘cc’ box of email correspondence.
Work continues to set up domiciliary home care providers and mental health/learning disability homes/assisted living providers with NHSmail shared accounts. These accounts will be issued in due course.
Our team relies on the use of secure email such as nhs.net email for the safe transfer of medical information to and from care homes. For example, to send our medication review documents or when medication changes need to be communicated to a care home and the dispensing pharmacy.
During the fast track roll out, the requirement of care homes and care providers to complete and submit their Data Security Protection (DSP) toolkit was waived until the end of September 2020.
Over the next four months support will be offered to care homes and care providers to complete or undertake their annual review of the DSP toolkit through a series of scheduled webinars and from the Local Authority and/or local CCG NHSmail fast track representative as required.
On-line ordering of medication
Our care home team continues to support the roll out of on-line ordering of repeat medication in care home settings across Bedfordshire. All GP surgeries across Bedfordshire are aware of and fully support this project and local pharmacies will also be notified.
This process would allow you to order repeat medication on-line (via SystmOne) directly from the GP surgeries website. All GP surgeries across Bedfordshire use the same clinical system called ‘SystmOne’ and this includes the patient online service called ‘SystmOnline’.
We have attached some information for care homes which es a ‘set up guide’ and details of the process involved: