COVID-19: Palliative Care Medicines in Care Homes
NHSGGC approved palliative care protocols were introduced in May 2020 to provide prompt symptomatic relief for care home residents suffering from Covid-19. The protocols allow care homes to keep stock of a specified list of medicines supplied via stock order from a GP (one GP practice allocated per care home to do stock order). Protocols are based on 3 levels of medicines, however, the stock supplied does not include controlled drugs. Standard just in case (JIC) prescriptions for controlled drugs remain as before (Level 3 medicines).
Key Messages:
- Care homes should ensure any stock used is replenished by requesting further stock orders
- Pre-authorisation forms should be completed for new residents if appropriate
- JIC prescriptions kept at the care home should only be sent for dispensing if needed
Level 1 (over the counter/homely remedies) and Level 2 (non CD prescription only) medicines
Pre-authorisation forms should be in place for Level 1 and Level 2 medicines for all appropriate residents. Forms should also be completed/signed by the GP/prescriber for all new residents admitted since May 2020 where appropriate.
In addition to the pre-authorisation form, Level 2 medicines also require verbal authorisation from a prescriber at the time of initiation. Residential homes without regular nursing input should not stock Level 2 medicines. This policy will continue for the duration of the pandemic and procedures will be put in place to remove stock when the pandemic is over.
Level 3 medicines (individual patient JIC prescriptions)
The GP may decide it is appropriate to issue JIC prescriptions to residents if there is a positive Covid-19 case in a particular unit/floor of a care home. These prescriptions should be stored securely at the care home, recorded, and only sent to the community pharmacy for dispensing when needed for that individual resident. As these prescriptions contain controlled drugs, they will expire after 4 weeks. If unused, they should be destroyed by shredding at the care home and recorded. The GP will decide if it is clinically appropriate to re-issue these prescriptions.
Protocols
Protocols which include stock list, pre-authorisation forms and flowcharts, can be found on the NHSGGC palliative care website https://www.palliativecareggc.org.uk/?page_id=2370
Repurposing Medicines in Care Homes Guidance
The repurposing guidance remains in place, please see below for the blog published in June 2020 https://ggcmedicines.org.uk/blog/medicines-update/repurposing-medicines-in-care-homes/
NHSGGC ‘For Care Homes’ website
This section of the NHSGGC website provides a central place for care home managers and staff to access up to date information, guidance and training resources www.nhsggc.org.uk/your-health/health-issues/covid-19-coronavirus/for-care-homes/
Published 23/12/20. Medicines Update blogs are correct at the time of publication