27 May Reuse of medicines in care homes during COVID-19
With the risk that COVID-19 might affect the availability of medicines, NHS England issued new guidance for care homes allowing them to re-use medicines between residents, rather than destroy them or send them back to the pharmacy. The full guidance is here: https://www.gov.uk/government/publications/coronavirus-covid-19-reuse-of-medicines-in-a-care-home-or-hospice).
This guidance applies to care homes and hospices in England, only during the COVID-19 pandemic, and only in certain circumstances.
We’ve read through the guidance (all 13 pages of NHS legal speak!) and summarised it here. We have to say we think it’s unlikely you’ll need it, as most community pharmacies have become pretty good at managing supply problems, also the criteria you have to meet are pretty stringent.
What are the criteria?
So, you can only re-use a medicine if:
- A resident needs it, but no pharmacy can supply it (or an alternative) in time
- A registered health professional (nurse, pharmacist, pharmacy technician or GP) checks the medicine is okay to re-use. They can check it virtually (over a webcam via Zoom, Skype etc.). They have to check it’s in date, in a manufacturer’s sealed box or blister strip (for tablets/capsules)
- It’s been stored correctly (in the fridge or out of sunlight, heat etc.)
There are a few things you’ll need to do as well:
- Store any medicines for re-use in a sealed container marked ‘patient returns’
- If the medicine has come from a person with COVID-19, it must be double bagged, with a ‘do not use before’ sticker added, quarantined for three days, and stored separately from other medicines
- You’ll need permission to re-use the medicine from both the resident it was originally prescribed for and the resident who needs it now. Use their power of attorney if they lack capacity or next of kin if they have died. It might be worth getting this permission from all residents
- You can’t give the medicine to another care home/hospice (even if they are owned by the same company or ask really nicely…)
Keep a log book
You have to keep a log of re-used stock, with the drug name, batch number, strength, formulation, expiry date, quantity and details of the registered healthcare professional who assessed the medicine. When the stock is re-used, record the person it was used for and quantity. There’s an example log book in the guidance.
For schedule 2 CDs (and any other you normally record in the CD register) you’ll need to record them booked out for the old resident and then booked in again (as received) for the new resident. Record that the stock is being re-used.
As you can see, there are quite a few hoops to jump through so maybe just hold onto more obscure medicines, medicines that have been out of stock in the past, or emergency medicines such as buccal midazolam or adrenaline pens.
You’ll need space to store these medicines until they are needed or until they go out of date, so realistically you can’t keep everything.
Finally, only re-use a medicine if the pharmacy contacts you with a supply issue. They’ll ask if you have a medicines re-use scheme and if you have any stock.
What about the pharmacy label?
The guidance doesn’t say anything about changing the pharmacy label, which will have the wrong client name on it and possibly the wrong directions. Our advice is that is safer to amend the pharmacy label with the new client name, and possibly directions (if there is room, or add another label). It’s a myth that you are not allowed to write on pharmacy labels. Have a second person check you have amended the label correctly and that you have entered it on the MAR correctly.
And now the cheeky plug…
We’ve developed focused and comprehensive online medication training (that does more than just tick a box) which can help ensure staff are competent to administer medication in this pandemic. For more details click here: Online Medication Training
We hope this helps, stay safe.
John Greene and Michael Stewart BSc (Pharmacy)
The Medication Training Company