The National Institute for Health and Clinical Excellence (NICE) has amended recommendations on managing medicines in care homes and hospices for patients at the end of life, in line with UK Government guidance on re-using medicines during the COVID-19 pandemic.
NICE's guideline, "COVID-19 Rapid Guideline: Managing Symptoms (including at the end of life) in the Community", has been developed using the interim process and methods for developing rapid guidelines on COVID-19, and is available at https://www.nice.org.uk/guidance/NG163.
On 28 April, the NHS England and NHS improvement standard operating procedure (SOP) was amended to replace the attachment "Novel Coronavirus (COVID-19) Standard Operating Procedure: Running a Medicines Re-use Scheme in a Care Home or Hospice Setting" and a flowchart on page 12 was updated. The updated information is available at https://www.gov.uk/government/publications/coronavirus-covid-19-reuse-of-medicines-in-a-care-home-or-hospice.
The change follows calls from the Royal College of General Practitioners (RCGP) for a temporary relaxation of laws so that controlled drugs can be repurposed and used for patients who need them during the COVID-19 pandemic. The college warned that patients were experiencing "unnecessary" pain and distress in the last days of their lives during the COVID-19 pandemic due to laws restricting the use of controlled drugs.
The Care Quality Commission (CQC) updated its advice on re-using named patient drugs as medicines supply in England on 1 May. It restates that "prescription-only medicines (POMs) must only be supplied on prescription to a named person. Once prescribed, the medicines become the property of that named person. The person must not supply that POM to anyone else. Therefore prescribed medicines cannot be used for anyone else”.
However, the CQC admits that coronavirus pressures might make it more difficult to ensure people receive timely access to essential prescribed medicines and care homes may need to act in a way that is pragmatic and safe, and focus on what is in the best interest of patients and the wider system, and the local schemes on medicines re-use may already be in operation to support this.
Following the publication of NHS England and NHS improvement's SOP on running a medicines re-use scheme in care homes and hospice settings, the CQC advises that the scheme should only be considered where there is an immediate need for the medicine and either:
no other stocks are available or
no suitable alternatives exist for an individual.
A risk assessment should be carried out on an individual medicine basis. The SOP sets out the criteria for medicines to be re-used, which must be checked by a registered healthcare professional and which may be done virtually.
The CQC's guidance is available at https://www.cqc.org.uk/guidance-providers/adult-social-care/re-using-named-patient-drugs-medicines-supply.
Last reviewed 13 May 2020