Care homes have been told that they may reuse medication in a crisis situation, if the patient for whom it was originally prescribed no longer needs it – for example if they have died.
The temporary guidance from the Department of Health and Social Care (DHSC) comes as clinicians and organisations – including the RCGP – had called on the Government to relax rules amid concerns around low stocks of palliative and other pain relief medication during the pandemic.
Reasons for the repurposing may include if a patient dies; or if the supply of their medicine is interrupted, in which case they may receive another patient’s surplus medicine.
The news comes as the Covid-19 death toll from care homes has now topped 3,000, based on latest ONS statistics, as total deaths in the UK have now reached over 26,000.
Care home or hospice staff still need to obtain a new prescription on behalf of their patient before reusing any medication.
The guidance makes clear that medicines can only be reused if:
- No other stocks of the medicine are available in an appropriate timeframe (as informed by the supplying pharmacy) and there is an immediate patient need for the medicine.
- No suitable alternatives for an individual patient are available in a timely manner i.e. a new prescription cannot be issued, and the medicine(s) supplied against it in the conventional manner quickly enough.
- The benefits of using a medicine that is no longer needed by the person for whom it was originally prescribed or bought, outweigh any risks for an individual patient receiving that unused medicine.
The guidance said: ‘Under usual circumstances, the re-use or recycling of another patient’s medicine is not recommended by the [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.’
During yesterday’s daily coronavirus briefing, health secretary Matt Hancock said: ‘We have to make the best possible use of all the medicines that we have.
‘We’re updating the guidelines for the use of medicines in care homes, removing a barrier so that for the period of the pandemic, where it’s clinically appropriate, medicines that have been labelled for use by one patient can be used by another patient who needs them, instead of being destroyed.
‘Clinicians and colleagues in social care have called for this change and it’s already standard procedure in hospitals.’
RCGP chair Professor Martin Marshall said the guidance was ‘a significant step forward that will make a genuine difference to patients at or nearing the end of their lives, and their families, during this pandemic’.
He said: ‘It’s vital that patients at or nearing the end of their lives receive the care they need – and having the right medication when they need it is key to this.
‘We’re pleased that the Government has responded to our call for a temporary relaxing of laws so that controlled drugs can now be repurposed and used for patients who need them during the Covid-19 pandemic.’
But he added that, with the guidance only applying to care homes and hospices, ‘there is still work to be done to ensure patients living in their own homes have appropriate access to necessary medication in a timely way’.
Oxfordshire GP partner Dr Helen Miles told Pulse: ‘Credit where it’s due. This is a vital change and will help reduce avoidable suffering.
‘There have been supply issues with a whole variety of drugs during the pandemic – paracetamol and clenil two obvious ones – and a fear that the same could happen with palliative care drugs.
‘Prior to the new guidance if, for example, we had prescribed “just in case” drugs for a patient who then died or didn’t need them for whatever reason, the care home would destroy them or send them back to a pharmacy to be destroyed.
‘This change means that if there was another person who urgently needed the drugs within the home they could be used. I’m not aware of particular shortages of these medications in our area currently but it’s about thinking ahead and trying to feel that we’ve ensured rules don’t get in the way of providing patients with the drugs they need.’
A DHSC spokesperson said: ‘As part of our national efforts to respond to the coronavirus outbreak, we are doing everything we can to ensure patients continue to access safe and effective medicines.
‘The quality, integrity and safety of medicines are paramount and this guidance will ensure that no patient is needlessly left without the treatment they need while protecting individuals at the end of life at this unprecedented time.’
Guidance to prescribers on the reuse of medicines
- When medicines are out of stock and there is an immediate need for them, an alternative preparation should be prescribed and dispensed, as is usual practice where possible.
- Where stock is not available, the supplying pharmacy will contact the care home or hospice to establish whether a medicines re-use scheme is in place and stock of the required medicine is available in the home.
- Re-used medicines may be administered to residents in a care home or hospice under the direction of a prescriber, and in line with this SOP, where an appropriate medicines re-use scheme is in operation.
- In this situation, the direction would normally be in the form of a prescription. If a prescription is issued remotely, it should be scanned and emailed to the care home by the prescriber (for known medicines shortages) or the community pharmacy as appropriate in each individual case.