Medication and Care Homes

Today, the BBC is reporting on a research study from the University of London which finds that seven out of ten residents out of the 256 residents in 55 different care homes were subject to errors in their medication regime.

The summary of the report suggests that the reasons for this are

inadequate information, over-worked staff, poor teamwork and often complex courses of medication

I wonder how much of these issues could be addressed by better training and better staffing levels – the things that often can be the most costly.

I spent 7 years working in residential homes before I qualified (and while I was training). I know that however good the regulation is, there is always scope for errors and rushed jobs because unless CCTV cameras are placed in all areas, there is a lot of scope for people to work individually and to make mistakes – sometimes the mistakes are honest and due to wholly understandable issues, noone can legislate for human error, but sometimes they are due to tiredness due to packing in tons of overtime as the pay is so poor, sometimes because there is a lack of knowledge and system management to ensure that medication management is prioritised and sometimes it is down to staff just plain not caring enough to do a good job although that is by no means the only reason.

Looking at the errors picked up most frequently in this study, they are

wrong dosages, insufficient monitoring of residents after medication had been taken and people being given the drug at the wrong time

I’m not sure how wrong dosages can be explained away but I can understand insufficient monitoring and drugs given at the wrong times because those can often be matters of staffing levels, especially in some of the larger care homes. I worked in a small home where there were five residents and there were always between two and three members of staff on duty at any given time, so medication management could be individualised and monitored but in some of the care homes I visit now with up to 80 residents, the level of staffing may not allow for such individualised care. It isn’t right, but it is cheaper.

This is also an issue which is brought up by the changing and more complex needs of those who are needing residential and nursing care. Whereas in the past, the idea of a convalescent or rest home was more of a longer term stay issue, now it is only people who can no longer be supported at home due to complex needs that are accessing residential care, meaning that there are more extensive medication needs.

At least a report that highlights this can focus some more attention on the needs of those who do need residential care. Hopefully, it will concentrate the minds of those who commission services and provide placements as well.

6 thoughts on “Medication and Care Homes

  1. Medication issues in care homes seems to be a recurring issue, and I agree with the points in this blog but I would like to add a couple of points.

    The National Minimum Standards currently require all medication training to be ‘accredited’ but there is no national body who does this so perhaps it is time to give that responsiblity to one of the many social care quangos.

    Also we see many reports on care home medication but I would really like to see some comparative data with the NHS.

    Are drug errors more or less frequent in care homes compared to hospitals? It would be wrong to have this constant criticism of care homes if hospitals themselves also have significant errors.

  2. From what I have read of the report it seems that they have identified problems as starting outside of care homes in terms of GPs prescribing ‘habits’ and pharmacists dispensing. When these factors are taken together with the points made about the pressures arising from the increasingly complex needs of older people moving into care homes it is perhaps unsurprising that mistakes occur.

    What I find more worrying is that the last (and final) report from CSCI on the state of social care in England once again highlighted shortcomings in this area – with only 67% of homes managing to meet or exceed the minimum standard for managing medicines.

    Since the introduction of the star ratings system homes are now visited significantly less frequently. It had been claimed that this would lead to more resources being focused on those which need most attention.

    But a recent report from the Relatives and Residents Association, “Inspection in Action”, based on evidence collected by reviewing 100 randomly selected inspection reports of 1 star (adequate) homes suggests that this is not happening.

    • I have serious reservations about the sparsity of registration visits, particularly unannounced visits. I think if anything we need more visits rather than less and I don’t wholly trust the star system.

  3. Everywhere where I’ve witnessed problems with medication management, understaffing or underqualified staff was an issue. In one home for people with physical disabilities, there were two staff members during the day for twenty residents. Once when I was visiting there, there was one student nursing assistant (who are in the Netherlands not qualified for giving out meds unsupervised) and one with some other training but she wasn’t qualified for giving out meds. There were no RNs or LPNs or support workers with training in medication management.

    In my institution, the ward next to mine also has only one staff member (to fourteen patients) in the evenings, and sometimes they have someone unqualified for giving out meds (eg. a social worker without additional training). Fortunatley people can come over to our ward for their meds if this is the case.

  4. CQC has worked with Skills for Care to publish a national standard for such training. The College of Pharmacy practice does accredit training delivered by pharmacy organistions into care homes to this national standard. The challenge is not really about knowledge giving, rather about ensuring that staff are competent to do the jobs asked of them 0 and the only way to do this is by observation.

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