Care Homes: Reducing medicines waste

Good Practice Guidance: Reducing Medicines/Dressings/Appliances Waste in Care Homes

For care home staff, prescribers and pharmacists working with care homes

Key recommendations

If medication, dressing or appliances are still being prescribed for a resident and are in date:

Do not throw them away at the end of the month, carry them over and use them for the same resident the following month*
Do not re-order the item(s) if it is not needed

*This does not apply to part used Monitored Dose Systems. These should be disposed of at the end of the month. Any unused medication should be reviewed.

All members of staff involved or responsible for the management of medicines within care homes have a responsibly to ensure NHS resources allocated for medicines are used efficiently. Care home residents are often on eight or more medicines. Having good procedures for ordering, storing, administering and reviewing medicines can help reduce waste. Local issues include:

Unused medicines that the resident is currently prescribed are being thrown away at the end of the month
Medicines are being prescribed that are rarely used to ensure supply is available when it is needed
Medicines are being over ordered and stockpiled

Ordering medication

Care home providers should retain responsibility for ordering medicines from the GP practice. This can be done via Proxy Access, for more information please see link
The responsibility should not be delegated to the community pharmacy
The care home should have a monthly ordering system for medicines
Ordering processes should ensure previous usage of medicines is reviewed before re-ordering. If the medication is not needed it should not be ordered
If residents continually refuse to take medicines discuss with the prescriber before re-ordering.
Medication can be used until the expiry date recommended in table 1 and does not need to be re-ordered automatically each month. The waste log should be reviewed regularly to ensure medicines are not being returned and re-ordered each month

When a resident has died, returned home or moved to another care home, advise the GP surgery and pharmacy as soon as possible to prevent a whole month’s worth of medication being issued when no longer required

Medication review

Any medication that the resident is no longer taking should be crossed off the MAR chart. GP and community pharmacy records should be updated to reflect this.

When required (PRN) medication

With “when required” medicines, there must be systems in place to ensure that stock levels are kept at safe levels and date expired medication is not given i.e. stock rotation.
Should be dispensed in their original packs whenever possible to give their longest shelf life
It is recommended that Care Homes develop clear, individualised “prn” protocols for each “prn” medicine so that staff are clear of the reasons for each prescription for each resident

Dressings

Check stock levels before ordering any dressings
Only order once a week, maximum twice weekly
Only order for a maximum of a two-week supply, wounds can change and will require a different dressing

Catheters

Repeat catheter orders should only be for 1 month supply
Appliances/accessories that last longer than 1 month should not be requested monthly

Residents only need to keep two catheters in stock at any one time, in case of catheter insertion failure

Medication/Dressing/Appliance	Recommended expiry date	Comments/guidance
Tablets and capsules:
· In Monitored Dose System (MDS)	Eight weeks
· In original packs	Manufacturer’s expiry date	Medicines kept for use in the next cycle should be recorded in the carried forward section of the MAR chart
· Loose tablets within a container	Six months from the dispensing date or pharmacy label expiry date where shorter	Medicines kept for use in the next cycle should be recorded in the carried forward section of the MAR chart
·
Ointments:
· In a pump dispenser	Manufacturer’s expiry date or manufacturer’s recommendation where shorter	Write date of opening on dispensing label
· In tube	Six months once opened or manufacturer’s recommendation where shorter. If unopened, follow manufacturer’s expiry date	Write date of opening on dispensing label
· In tub with lid	Three months once opened or manufacturer’s recommendation where shorter. If unopened, follow manufacturer’s expiry date	Write date of opening on dispensing label
Creams:
· In pump dispenser	Manufacturer’s expiry date or manufacturer’s recommendation where shorter	Write date of opening on dispensing label

· In tube	Three months once opened or manufacturer’s recommendation where shorter. If unopened, follow manufacturer’s expiry date	Write date of opening on dispensing label
· In tub with lid	One month once opened or manufacturer’s recommendation where shorter. If unopened, follow manufacturer’s expiry date	Write date of opening on dispensing label
Others:
Liquids	Six months once opened or manufacturer’s or pharmacist’s recommendation where shorter	Write date of opening on dispensing label
Suppositories/pessaries/rectal tubes/patches	Manufacturer’s expiry date
Glyceryl trinitrate (spray)	Eight weeks after opening (spray – manufacturer’s expiry date)	Write date of opening on dispensing label
Ear and nose drops and sprays	Three months once opened, unless manufacturer advises otherwise. If unopened, follow manufacturer’s expiry date.	Write date of opening on dispensing label
Eye drops	28 days once opened. If unopened, follow the manufacturer’s expiry date.	Write date of opening on dispensing label
Insulin	28 days once opened, can be stored outside of the fridge. If unopened and stored in a fridge between 2^o and 8^o follow manufacturer’s expiry date	Write date of opening on pen/cartridge
Inhalers	Manufacturer’s expiry date. Note some inhalers may have shorter expiry date once dispensed or opened. Refer to the patient information leaflet or instructions from your pharmacy.
Inhalers with capsules	Refer to manufacturer’s expiry. The expiry may vary for both the device and capsules. See Patient Information Leaflet for instructions on cleaning device where appropriate.	Follow manufacturer’s instructions for cleaning device
Dressings & Appliances	Refer to manufacturer’s expiry. For nursing homes use stock where possible. If ordered on an FP10 prescription use only for that patient. Only order more if needed.

**Adapted from Oxfordshire Clinical Commissioning Group Guidance