CQC report on better medicines optimisation

June 7, 2019

The Care Quality Commission (CQC) has released a new report describing lessons for better medicines optimisation across health and social care providers and the positive impact of involving pharmacy professionals these settings.

CQC states that when medicines are managed and used effectively, providers can not only improve outcomes for people, but also drive improvements in overall care, reduce wastage and involve people in their own treatment. This is the goal of medicines optimisation.

However, a recent study estimated that 237m medication errors occur in England each year and there is work to be done to make sure that everyone has access to high-quality, safe care.

The report includes examples of positive outcomes in a variety of services thanks to the input of pharmacy professionals, from helping to upskill care home staff on medicines, to direct involvement in reviewing people’s medicines at the point of discharge from one setting to another.

Medicines in health and adult social care: Learning from risks and sharing good practice for better outcomes is based on qualitative and quantitative analysis of over 200 inspection reports of NHS and independent providers where CQC knew there were medicines-related issues, 100 enforcement notices (such as Warning Notices) and 1,500 National Reporting and Learning System (NRLS) and statutory notifications from providers between 2015 and 2018.

As well as learning for people working in primary care, mental health, adult social care and hospital settings, there were common areas for improvement across health and care, including staff competence and workforce capacity; reporting and learning from incidents; prescribing, monitoring and reviewing medicines; and transfer of care.

For adult social care, the report on medicines optimisation makes six recommendations. These are:

  1. Adopt best practice guidance, specifically NICE guidance for managing medicines in care homes and in the community.
  2. Consider having an attached or named pharmacist to support staff with issues around the use of medicines. This can help to implement guidance and training on administering medicines covertly, ‘when required’ (PRN) medicines, and those required as part of end of life care.
  3. Train and assess staff in handling and administering medicines as an ongoing priority. It should be clear who is responsible for training staff about medicines and that this training is kept up to date.
  4. Make clear who has ongoing clinical responsibility and oversight of medicines. Expectations around responsibility should be clear in the contracts that local authorities and CCG commissioners issue to providers.
  5. Consider hiring a nursing associate, which may help to ease pressure on nursing staff in care homes, but make sure that they are deployed safely and effectively, with the  appropriate competencies and supervision when their work involves medicines.
  6. Adopt NHS England initiatives such as Enhanced Health in Care Homes and Medicines Optimisation in Care Homes to help drive improvement by involving pharmacists and providing joined-up primary, community and secondary care to residents.

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