Reducing medicines, dressings and applicances waste in care homes

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

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Key recommendations

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

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

*This doesn’t apply to part used monitored dose systems. You should dispose of these at the end of the month and review any unused medication.

Staff involved or responsible for managing medicines in care homes have a responsibly to ensure NHS resources allocated for medicines are used efficiently.

Care home residents often take 8 or more medicines. Having good procedures for ordering, storing, administering and reviewing medicines can help reduce waste.

Local issues include:

• unused medicines being thrown away at the end of the month
• prescribed medicines that are rarely used to ensure supply is available when it’s needed
• over ordering and stockpiling medicines.

Ordering medication

Care home providers should retain responsibility for ordering medicines from the GP practice. This can be done via proxy access.

The responsibility shouldn’t be delegated to the community pharmacy. The care home should have a monthly ordering system for medicines.

Ordering processes should include a previous usage review before re-ordering. If the medication isn’t needed you shouldn’t order it.

If residents continually refuse to take medicines, discuss with the prescriber before re-ordering.

You can use medication until the expiry date recommended in the table below and doesn’t need re-ordering automatically each month. You should review the waste log regularly to ensure medicines are not being returned and re-ordered each month.

Monitor medicine disposal to identify trends and discuss with prescriber or the person ordering medicines.

If a resident dies, returns home or moves to another care home, tell the GP surgery and pharmacy as soon as possible to stop the issue of a month’s worth of medication when it’s no longer needed.

Medication review

Any medication that the resident no longer takes should be crossed off the MAR chart. GP and community pharmacy records need updating to reflect this.

When required (PRN) medication

With ‘when required’ medicines, yoou must have systems in place to keep stock at safe levels and date expired medication isn’t given.

PRN medication should be dispensed in their original packs whenever possible to give their longest shelf life.

Care homes should develop clear, individualised PRN protocols for each PRN medicine so that staff know the reasons for each prescription for each resident.

Dressings

You should:

• check stock levels before ordering any dressings
• only order once a week (maximum twice weekly)
• only order for a maximum of a 2-week supply. Wounds can change and will need a different dressing.

Catheters

Repeat catheter orders should only be for 1 month’s supply.

Appliances/accessories that last longer than 1 month shouldn’t be requested monthly.

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

Inhalers

Inhaler technique should be checked and review by an appropriately trained health professional. When appropriate, provide a spacer device.

Check that the dose and number of inhalers prescribed synchronised with the monthly cycle. For example, Seretide Evohaler® contains 120 doses so if the dose is 2 puffs twice a day, you’ll need 112 doses. One inhaler would be enough for a month’s supply.

Reliver inhalers intended for ‘as when needed’ use don’t need monthly re-ordering. If a resident has a spare inhaler, you can order a new prescription when
the one in use runs out.

Oral nutritional supplements

Remember food first! Follow local guidance.

These are supplements and should be given between meals.

On-going need should be reviewed periodically. Tell the prescriber about current weight, BMI and MUST score on a monthly basis.

 

Medication/dressing/appliance	Recommended expiry date	Comments/guidance
Tablets and capsules
In Monitored Dose System (MDS)	8 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	6 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	6 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	3 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	3 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	6 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)	8 weeks after opening (spray – manufacturer’s expiry date)	Write date of opening on dispensing label
Ear and nose drops and sprays	3 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 2C and 8C 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 and 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.

Further reading

Care home – reducing medicines waste in care homes: information for care home staff.