Guidance published on medicines re-use in care homes and hospices

Guidance published on medicines re-use in care homes and hospices

April 29, 2020

The Department of Health and Social Care (DHSC) and NHS England and NHS Improvement have published guidance on running a medicines re-use scheme in a care home or hospice setting during the COVID-19 pandemic.

The guidance/standard operating procedure (SOP) is intended to support timely access to essential prescribed medicines during the COVID-19 pandemic for patients who are being cared for in a care home or hospice setting in England. It notes that under usual circumstances, the re-use or recycling of another patient’s medicine is not recommended by 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.

The document states that as 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.

If a medicines re-use scheme is put in place, a care home or hospice must carry out a risk assessment for each potential re-use of a medicine. Three key indicators should inform the risk assessment and the subsequent decision on whether or not to re-use a medicine:

  1. 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;
  2. 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; and
  3. 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 document sets out criteria against which a medicine must be checked by a registered healthcare professional to determine whether it is suitable for re-use. It also notes that such checking may be undertaken by pharmacists, pharmacy technicians or other registered healthcare professionals working for clinical commissioning groups, general practices or community healthcare trusts.

Community pharmacy’s role

Notwithstanding the pandemic’s potential impact on the supply of medicines, particularly those used in end of life care, the actual re-use of medicines via a scheme described in the guidance/SOP will hopefully be an extremely rare occurrence, so most community pharmacy teams are unlikely to come across such a scenario and it is those that regularly supply medicines to care homes and hospices that are most likely to need to be aware of the operation of medicines re-use schemes. Those pharmacies may want to discuss with the managers of care homes and hospices they provide services to, whether a medicines re-use scheme is being planned.

The guidance states that 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 (e.g. out of hours), the community pharmacy team that supplies the care home or hospice 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. Where the care home or hospice do not have a procedure in place to allow interim additions or amendments to MAR charts in their possession, the pharmacy could issue a new MAR chart for the product that is to be re-used.

A copy of the prescription could potentially be shared by sending an image of the prescription via NHSmail, where the care home has access to NHSmail. 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.

Pharmacists and pharmacy technicians working within community pharmacies could potentially undertake checks  at the care home or hospice on medicines being considered for re-use, but it should be noted that this is not a task that is required to be undertaken as part of the NHS Community Pharmacy Contractual Framework and any professional undertaking this role must ensure they have appropriate indemnity insurance arrangements in place.


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