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The Patients Association – Care home staff version of the Charter
The Patients Association’s Care Home Charter is an evidence-based and expert-led tool to help improve medication practices for people living in care homes across the UK.
This page goes into more detail about how healthcare professionals can improve medication management.
As a professional working in a care home, I must have the requisite knowledge and skills to:
1. Identify and respect the resident’s wishes and beliefs about medication
Staff should take time to sit down with residents and relatives to find out what their wishes, preferences and religious beliefs are and when they would like them to be considered.
- always record meetings
- record instances where residents state they do not wish to take medicines
- respect, understand and document the resident's wishes
2. Involve and support the resident and/or those important to them to make shared decisions about medication
- actively identify the most appropriate relative or person with power of attorney
- consider other healthcare professionals e.g. GP, pharmacist, carers, nurses and anyone else who may know the resident very well
- record decisions in care plans and share this with relevant members of the team
- ensure residents are at the centre of any decision making
- Polypharmacy is the prescribing of multiple medicines to one individual. This can be appropriate as older people tend to have multiple conditions. Inappropriate polypharmacy can cause adverse effects.
Medicines optimisation reviews ensure that residents receive medicines which improve their quality of life. The benefits gained from medicines must outweigh the risks. This ensures that medicines don't interact with each other or with any disease the resident may have.
3. Involve the resident I care for in regular medicines optimisation reviews by a multidisciplinary team
Staff must ensure that a review has been conducted which:
- identifies the dose of medicines which is most effective for the resident
- identifies the formulation which is acceptable to the resident
- ensures any changes that have been made is documented in the care plans
- involves the appropriate healthcare professionals e.g. GP, pharmacist or community geriatrician
- ensures the involvement of residents in any medicines optimisation review
4. Assess monitor, administer and review medication to ensure that the resident receives medication safely and in an appropriate form and route
- ensure medicines administration is safe
- identify and report any refusal to take medicines
- record any changes to the resident's status which may be related to medicines
- identify and report any residents with swallowing difficulties
- ensure awareness of their own responsibilities with respect to medicines review
- undertake regular training and attend update courses
5. Only administer medicines in line with local covert medication policy and the guidance of the Court of Protection
Staff must ensure that covert administration only be used:
- as a last resort when all other methods have been tried
- when the resident lacks capacity to make decisions
- when there has been a formal 'best interests meeting' approving this
- when the resident's doctor confirms this as a medical necessity
- if the best interest's assessor has reviewed the decision and agreed with it
Staff must ensure that the best interests meeting:
- is recorded
- states clearly how the medicines should be administered
- states when and how the decision will be reviewed
Staff must ensure that covert administration is:
- used for the minimum possible time
- not deemed to be a breach of Human Rights
- authorised using the Deprivation of Liberty Safeguards process
6. Make sure an advance care plan, which includes medication, is in place for the resident, with a regular review when their condition changes.
Staff must ensure that:
- discussions between the resident, family members and multi-disciplinary team members are enabled
- within these discussion, advance decision care plans and how these relate to residents medicines are considered
- any decisions, wishes or preference not to take medication, is recorded in the care plan as part of advanced decisions
- they monitor progress and trigger discussion with the multi-disciplinary team when necessary
7. Work with other members of the multidisciplinary team to ensure that the resident’s medication needs are met.
As people, have increasingly advanced degenerative conditions they have increasingly complex and more difficult nursing needs.
Members of the multi-disciplinary team have unique knowledge and skills which can be used to support the residents.
Speech and language therapists:
- advise where the swallowing difficulty may arise i.e. mouth, throat or oesophagus
- provide advice on appropriateness of oral feeding
- review nutritional status of the resident
- ensure residents weight is maintained
- review oral hygiene, appropriateness of dentures
- ensure formulations are appropriate
- identify the need for medicines to be crushed or altered
- ensure that eating is a meaningful activity
- identify the need for adaptations to help with eating
- identify the appropriate posture for the resident
- identify if the resident needs aids or help with their posture
- ensure that the goals and aims of treatment are still appropriate
- identify when to involve the relatives
- ensure an advanced life directive is in place
Communication is key, and staff must ensure that care records are shared within the multidisciplinary team and they know how to contact the agencies.
8. Make sure that optimal oral and dental care is provided for residents
Residents with swallowing problems may have poor oral hygiene. This increases the likelihood of chest infection if they aspirate i.e. food, drink, or medicines go into the lungs inadvertently.
When cleaning a resident's mouth, staff should ensure they:
- wash their hands and use clinical gloves
- use a small infant-size soft toothbrush first (then move on to medium size toothbrush)
- use a smear of mild mint fluoride toothpaste
- guide the resident with gentle hand on hand movements to enable them to do the movement themselves
- touch and clean the outside of the mouth first
- clean the outer edges of teeth and gums
- clean the inside of the mouth, gums, teeth and the palate
- do not at any time put fingers between the residents teeth
Staff should ensure that they clean residents teeth at least twice daily or after every meal if the resident has poor oral health.
9. Recognise and manage swallowing problems to ensure appropriate referrals are made
Staff should look out for the signs of difficulty such as:
- coughing or choking soon after swallowing
- food, fluid and medication remaining in the mouth after swallowing
- food and drink spilling from the mouth
- wet gurgled voice after taking a drink
- excessive oral secretions
- residents complaining of the sensation of food or fluid being stuck in the throat
It is important to ensure that posture and positioning are maximised during feeding. If residents require close supervision and assistance this should be provided.
If there is a new onset of dysphagia or a deteriorating swallow, then refer to local guidelines to make a referral to the speech and language therapist. If problems are severe then an urgent medical referral should be made. If the cause of swallowing difficulties is medication related, then discuss this with the GP or pharmacist for a review of medication to be conducted.
Get involved: Do you work in or manage a care home and want to adopt the Care Home Charter? We can support you to do just that – email firstname.lastname@example.org to express your interest.
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