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Care homes and intermediate care

Pharmacy teams to support care homes with 'clinical review' of patients amid COVID-19 response

An operational model for pharmacy teams has been published in response to a request from NHS England and NHS Improvement for pharmacy support in care homes.

Open access article

The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.

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Pharmacist giving older patient tablets


Along with providing staff, the pharmacy sector is expected to support care homes with its expertise and clinical information

Pharmacy teams will be expected to “support the clinical review” of patients in care homes as part of the NHS’s COVID-19 response.

An operational model, published by the Specialist Pharmacy Service on 19 May 2020, details four ways in which pharmacy teams will be expected to offer support, including working with multidisciplinary teams to prioritise care for patients; facilitating medication supply; advising care homes on medication use; and delivering structured medication reviews (SMRs).

It adds that local pharmacy leaders will draw up a “local workforce strategy and action plan” to “support the mobilisation and deployment of clinical pharmacy teams to support care homes”, as well as potentially set up a COVID-19 ‘Pharmacy and Medicines Care Home Task Force’ to deliver this work.

The model was published after NHS England and Improvement requested the provision of pharmacy and medication support to care homes in a letter on 1 May 2020, as part of a wider response to the outbreak of COVID-19 in care homes, which was described as posing a “significant challenge” to the sector.

As a result, the model states that “clinical, general practice, care homes and clinical commissioning group (CCG) pharmacists and pharmacy technicians, supported by specialist hospital pharmacists, and community pharmacy, are being asked to rapidly mobilise and join multidisciplinary primary and community care teams to support care homes, and implement this model”.

If teams do not have the capacity to support all care homes in their local area, it suggests the local taskforce “have urgent discussions, supported by the pharmacy leadership group and [Health Education England] pharmacy deans, with local organisations to identify additional staff”.

In addition to providing pharmacy staff, the sector will also support care homes through access to their expertise and clinical information.

“Community pharmacists and their teams can actively work with care homes pharmacists and pharmacy technicians in all aspects of medicines supply, including facilitating medication supply to care homes (especially end of life medication),” the model says, adding that ”a single point of contact for care homes for rapid advice on medicines and their use” should also be set up.

Pharmacists will also be expected to undertake SMRs with patients “via video or telephone consultation”.

The model adds that while “it is desirable” for these pharmacists to have independent prescribing training, “the current priority during the COVID-19 emergency demands a flexibility to provide urgent support for care home residents”.

Graham Stretch, chief pharmacist at the Argyle Health Group — which manages care for 1,000 nursing home residents in west London — was on the short-life working group tasked with developing the model, which he described as “a good, positive start”, adding that “we hope to be able to provide much more proactive, and less reactive, support”.

“The job now is to delegate this to regional and local levels,” he said. ”What we hope is that pharmacists and pharmacy technicians from any organisation — be it a CCG, a GP surgery, or a primary care network — come together with a mechanism based around a single access point.”

Prime minister Boris Johnson said in Parliament on 13 May 2020 that there had been a “terrible epidemic” of COVID-19 cases in care homes.

Commenting on this, Stretch said: “We need to try our best to put it right. Care homes have been challenged by the level and volume of work. It’s important that we put in practical, proactive support around medicines — and we don’t need to reinvent the wheel, we can use existing structures.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207991

Readers' comments (1)

  • Who is administering the medication?

    The use of medicine is common in healthcare and extensive research internationally has identified medication usage as the leading cause of unintended harm for patients. The medication-use process is complex, with a total of 54 identified phases (and numerous actors including pharmacists), for which many activities, tools, equipment, and information systems are needed and for which several interfaces are typically required. Many of these phases, particularly the medication administration process, carry high risks for patient and person administering medication (who may be a non regulated healthcare staff member).

    It is important that patients and their carers and prescribers are provided with a comprehensive service from their pharmacist who facilitates the safe and timely supply of medicines, as well as information and care to ensure the best possible outcome for each person. A structured set of policies and procedures should be in place to govern effective medicines management in long term care settings. Pharmacists are an essential component of any medication use process.

    Pharmacists should be aware who will be administering medication in the long term care setting. Pharmacists should be aware if the person administering medicines is the patient, a family member who has/has not some specific training, a volunteer, a registered qualified nurse, a non regulated health care worker with some basic training, a non regulated healthcare worker with no medication administration training. Risks will vary depending on the individual medication, personnel involved and location.

    The unregulated nature of healthcare assistants (HCA) has been highlighted in studies and reports and this is an issue for patient safety, professional conduct, educational standards and defining a scope of practice. HCAs should only administer medicines they have been trained, and are competent, to give. In care homes in the UK without nursing (that is, residential care homes), these will generally include:

    • Tablets, capsules or oral mixtures
    • Medicated creams or ointments
    • Ear, nose or eye drops
    • Inhaled medication (RPSGB, 2007).

    Administering medicines using invasive or specialised techniques will normally involve a registered nurse who has received up-to-date training.

    Threats to medication safety include miscommunication among health care providers (e.g. prescribers, pharmacists, nurses, family members) drug information that is not accessible or up to date, confusing directions from doctors and pharmacists, confusing labelling of dispensed medications, poor or unsafe administration technique, inadequate patient information, lack of drug knowledge (doctor, pharmacist, nurse, care staff, patient and/or family member), incomplete patient medication history, lack of redundant safety checks, lack of evidence-based protocols, and staff and/or family members assuming roles for which they are not prepared.

    Adverse events are common in health care with the incidence of medication administration errors high. Medication errors are among the most frequent adverse events. These adverse events may result in morbidity, mortality, increases in monitoring and costs of care.

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