Managing medicines: home care providers

Your policies should reflect the best practice laid out in the NICE guideline NG67 on managing medicines for adults in community settings.

Here are some key points from that guidance.

Medicines support from home care agencies

Medicines support is any support that enables a person to manage their medicines. In practical terms, this covers:

• prompting or reminding people to take their medicines
• helping people remove medicines from packaging
• administering some or all of a person's medicines.

Assessing medicines support needs

You should assess what medicines support a person needs as part of their general assessment. Record the outcome of the assessment in the care plan.

Where a person needs support with their medicines, record the following details in their care plan:

• the person's needs and preferences
• the person's expectations for confidentiality and advance care planning
• how you will seek consent
• details of who to contact about their medicines - this can be the person needing support or a contact they choose
• what support they need for each medicine
• how the medicines support will be given
• who provides medicines support, particularly when more than one care provider is involved
• when the medicines support will be reviewed - for example, after six weeks.

Other important points:

• staff who assess people's medicines support need to be trained and competent to do so
• only take responsibility for people's medicines where the assessment indicates there is a need.

Staff training and competency for providing medicines support

Home care workers should only provide medicines support when this is clearly documented in the care plan. The prescriber's directions must be clear, specific and unambiguous. You must give relevant training and support to home care workers who provide medicines support.

Home care workers must "have the necessary knowledge and skills". These should be updated annually. Home care workers should undergo competency assessments, which include being observed.

Specialised administration should be determined by the home care agency’s policy or commissioner’s guidance. It may require additional training.

Find out more about training and competency for medicines optimisation in adult social care.

Delegated tasks

In some circumstances, healthcare professionals may delegate certain tasks to home care workers.

Find out more about delegating medicines administration.

Ordering, transporting, storing and disposing of medicines by home care agencies

The person receiving medicines support (or their family/carer) will usually be responsible for ordering, transporting, storing and disposing of medicines. But if you take on this responsibility, you need to have appropriate processes in place.

When assessing medicines support, you should discuss storage, transport and disposal of medicines. Record the outcome of this assessment in the care plan.

Ordering and transporting medicines

If you are responsible for ordering medicines, you should identify and record:

• name, strength and quantity of medicine ordered
• date of order
• date medicines were received
• any discrepancies between what was ordered and received.

If you are responsible for transporting medicines, complete a risk assessment. You may need to consider the needs of cold chain medicines and medicines which are liable to misuse (such as controlled drugs). This is especially relevant if you're not going straight from the supplying pharmacy to the person’s home. For example, you may have other support calls to make in between.

Storing medicines

Agree with the person how they will store medicines. Record this in the care plan. Review this agreement at intervals appropriate for the person. This is particularly important where a person has declining or fluctuating mental capacity.

If you store medicines, your processes should cover safe and appropriate access. You could consider:

• who has access to medicines
• how to store them safely or securely.

Where a person stores medicines in their own home, they do not need a separate medicines fridge. You need to check that any fridge used to store medicines is in working order. You do not need to check the temperature every day (as would be done in a care home).

Disposing of medicines

Agree with the person how they will dispose of medicines. Record this in the care plan. The person should usually return unused or unwanted medicines to a community pharmacy. If they are unable to do this, the care plan should state how the home care worker will dispose of the medicines.

Your process should include what you will record when disposing of medicines. You should include the date of disposal, name, quantity, and who took them to which pharmacy.

You also need processes for disposing of medicines which need special considerations. This includes controlled drugs and sharps.

Administering medicines in home care agencies

Medicines administration records (MARs)

Poor record keeping can put people receiving medicines support and care workers at risk.

Find out more about medicines administration records in adult social care.

Leaving out doses

You must only leave out doses for a person to take later if you have agreed this with them and you have assessed the risk. Record this information in the care plan. And make an appropriate record on a medication administration record.

Sharing responsibilities for medicines support

Sometimes, family members will administer medicines. This could be on a day out or during overnight stays elsewhere. If this is the case, agree in advance how they should record this. Include this agreement in the care plan and make it available to care staff.

When required medicines

Find out more about when required medicines in adult social care.

Time sensitive medicines

Time sensitive medicines are those that need to be given or taken at a specific time. A delay in receiving the dose or omission of the dose may lead to serious patient harm.

Common examples include:

• insulin injections
• medicines for Parkinson’s disease
• medicines that contain paracetamol
• medicines that need to be given before or after food
• antibiotics.

Home care workers should be able to prioritise visits to meet the needs of people who need support for time-sensitive medicines.

Keep a record of responses from prescribers about queries to medicines.