Revised SOP on re-use of medicines in care homes, hospices during Covid-19

The Department of Health and Social Care has revised its guidance on the re-use of  prescribed medicines during the COVID-19 pandemic for patients in care homes and hospices in England.

The DHSC’s latest guidance or standard operating procedure (SOP) says: “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.”

The guidance makes it clear that medicines can be reused as along as:

• No other stocks of the medicine are available in an appropriate timeframe and there is an immediate patient need for the medicine
• No suitable alternatives for an individual patient are available
• 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 SOP stipulates that medicines must be checked by registered healthcare professionals (eg pharmacists, pharmacy technicians, general practitioners, community nurses) who can confirm that they are suitable for re-use.

If the medicine suitable for re-use is a controlled drug then it must remain in the control of an organisation authorised to do so. Appropriate records must be maintained in respect of controlled drugs, it adds.

It is a requirement that medicines that have been supplied to patients while in a care home or a hospice have not been removed from that setting and have been stored in accordance with good practice guidance on storing medicines in a managed setting. This applies to all medicines, including liquid medicines, injections (analgesics, insulin), creams and inhalers, that are in sealed or blister packs.

Heathcare providers should also consider, in the case of medicines that they have had difficulty accessing, whether the normal assumption of allowing patients to keep their own supplies of medicines for self-administration is appropriate, or whether other storage arrangements would better facilitate their re-use, if that patient no longer needs them.

Further guidance for pharmacy

The Pharmaceutical Services Negotiating Committee says that the new guidance is unlikely to affect most community pharmacy teams, although those that regularly supply medicines to care homes and hospices would need to be aware of the operation of medicines re-use schemes.

It advises these pharmacies “to discuss with the managers of care homes and hospices they provide services to, whether a medicines re-use scheme is being planned.”

They must bear in mind:

• 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 there is no suitable alternative or a prescription cannot be written for the alternative medicine (eg out of hours), the community pharmacy team should ask the care home or hospice whether they run a medicines re-use scheme and whether they have any stock of the required medicine.
• If stock of a re-used medicine is available in the care home or hospice, the community pharmacy team must share a copy of the prescription for that medicine with the home and update the corresponding MAR chart as necessary. The supply of the medicine by the care home or hospice will need to be in accordance with that prescription. They cannot rely on a report of its contents.