Standard operating procedure on how to run a safe and effective medicines reuse scheme in a care home or hospice during the coronavirus outbreak.
Managing medicines
NICE has issued good practice for managing medicines in care homes. The guidance
promotes safe and effective use of medicines in care homes by advising on processes
for prescribing (including remote prescribing), handling and administering medicines. It
also recommends how medicines (including controlled drugs) should be received, stored
and disposed of within a care home setting. That guidance includes a recommendation
that care home providers must ensure that medicines prescribed for a resident are not
used by another resident.
Although this remains good practice, this new Standard Operating Procedure is designed
to help providers manage situations where, during the COVID-19 pandemic, the best
interest of patients mean that it is not appropriate to follow this recommendation.
Recycling/re-use of unused medicines
1 The Care Standards Act 2000 defines a ‘care home’ as accommodation that provides nursing or personal care. 2 Hospice care aims to improve the quality of life and wellbeing of adults and children with a life-limiting or terminal
condition. It helps people live as fully and as well as they can to the end of their lives, however long that may be.
Provided that a supply is, in fact, in accordance with the prescription, for the specific
purposes of Part 12 of the Human Medicines Regulations 2012, it will generally not be
relevant how that medicine is sourced.
Accordingly, if at each stage of the supply chain the legal requirements relevant to that
stage have been adhered to, the possibility exists that providers may have in their
possession medicines that they are lawfully entitled to have in their possession for one
purpose which they may be able to use for another purpose. This new guidance is to
support making appropriate use of that recognised possibility in care homes and
hospices.
When a patient is prescribed a medicine, once the final supply of the medicine is
completed and it is in the patient’s safe keeping, it is their legal property. If the
medicine is still in the safe custody of the care home or hospice care provider,
whether or not the final supply to the patient has been completed is the subject of
differing legal views. Some would say that it becomes the patient’s property as early
as when it leaves the pharmacy.
This guidance does not seek to resolve these complex legal issues. Rather, it presents
an agreed line through them, in the current very unusual circumstances, and that agreed
line is strictly for the limited purposes which the guidance addresses.
Under usual circumstances, the re-use or recycling of another patient’s medicine is not
recommended by the Department of Health and Social Care (DHSC) as the quality of any
medicine that has left the pharmacy cannot be guaranteed. Any unused medicines would
normally be disposed of by returning them to a contracted external company or
community pharmacy.
However, there are increasing concerns about the pressure that could be placed on the
medicines supply chain during the peak of the COVID-19 pandemic. A medicines re-use
scheme for care homes and hospices could potentially ease some of that pressure in the
coming weeks.
Medicines re-use schemes already operate successfully in NHS hospitals across the UK.
In addition, hospices and care homes generally have good procedures in place to store
medicines in an appropriate way. We can therefore be more confident of the quality of
any unused medicines in these settings.
Due to the current unprecedented impact of COVID-19, DHSC and NHS England and
NHS improvement are recommending a relaxation of previous recommendations and the
NICE recommended good practice guidance to accommodate re-use of medicines, under
very specific circumstances and only in a crisis situation as outlined.
First and foremost, the quality, integrity and safety of medicines are paramount and the
best way to assure this is for pharmacies to supply medicines obtained through the
regulated supply chain, appropriately labelled for individual patients.
However, in the unprecedented COVID-19 situation, DHSC and NHS England and NHS
Improvement recognises that the re-use of medicines may be appropriate in certain
circumstances. It is recommended that medicines should only be re-used in accordance
with a medicines re-use scheme, set out in a SOP.
This SOP has been developed to support care home and hospice providers. It
offers a framework to run a safe and effective medicines re-use scheme that is in
the best interest of patients.
