I have in my kitchen a large box, a box that sits high at the far end of a tall cupboard. Within this box is a pharmacy of ‘delight’. Now before you start thinking I’m some magician with special powers or some dark dealing criminal, this box is my ‘just in case’ survival pack, the place I run to when sore throats, headaches and other gruesome ailments hit the Cooke household. I couldn’t be without my stockpile, and the thought of having to delay relieving my loved ones of symptoms that distress, to pop into town to pick up some more, keeps that box full to the brim. (Whilst the nurse in me ensures they are all in date and ready for use)!
I know this is not uncommon practice and to me this raises questions as to why it should be any different for someone living in residential care.
In care homes, keeping ‘over the counter’ medications are known as ‘homely remedies’, this enables peoples to have access to medication when they need it.
Historically, the system for using homely remedies included getting the residents GP to authorise the specific medications that could be made available for use for a set period of time. This provided assurance that there were no contraindications based on the medications that were already prescribed and that GPs were informed if symptoms persisted.
Homely remedies were also an opportunity for effective housekeeping of prescriptions and medication records.
However, times change and there has been a shift in GPs not wishing to authorise homely remedies for care homes. This has been supported by the BMJ who feel safest practice would be to receive over the counter medication following input from a community pharmacist. Sounds like an ideal solution, especially considering the drive to a move to pharmacy led care home support (as announced by NHS England), which enables pharmacists to be independent prescribers and be deployed by providers to support care homes.
The question is, what to do in the meantime? Well, a good start is to:
• Adhere to best practice recommendations, NICE are clear around the expectations for homely remedies within their guidelines (SC1/NG67) as well as the Care Quality Commission from their recent discussion Treating minor ailments and promoting self care in adult social care and these recommendations should be incorporated into a policy and local protocol. QCS have a policy specifically for the use of homely remedies in the home
• Await the much-anticipated updated Royal Pharmaceutical society of Great Britain, ‘The Handling of Medicines in Social Care guidance’ to see what further advice is available
• Have a discussion with your local GPs, pharmacists and CCG to identify local arrangements in place in your area.
So as the winter months fast approach I return to my box at the top of the cupboard. The cries of sore throats, stuffy noses and heavy heads anticipated, and I must prepare my reserves. Until the next newsletter, stay well.