The work described here was presented at the UKCPA Virtual Conference Poster Day 2021
Care home residents are particularly vulnerable and may require urgent access to medicines for distressing symptoms of COVID-19 or for end of life care.
‘Repurposing medicines’ is the term used to describe a situation where a medicine prescribed for one resident (the donor) is administered to another resident (the recipient) to allow immediate treatment in a situation where access to medication is not possible via normal routes.
Though not routinely recommended, this approach is based on key principles outlined in NHS England guidance and supported by the Scottish care home regulatory body.
Guidance for repurposing prescription only medicines in care homes and hospices during the COVID-19 pandemic was developed by a multidisciplinary group and launched in Scotland in May 2020, to provide a framework and support for care home staff.
Respondents demonstrated a high level of awareness of the guidance which was used appropriately and almost always with the involvement of a healthcare professional.
However, not all Health Boards in Scotland have implemented this guidance. An audit was undertaken to determine the awareness of, and adherence to, the repurposing guidance in care homes using the following criteria:
- 100 percent of care homes have a healthcare professional on the premises when the guidance is used
- 100 percent of care homes use the guidance for urgent end of life care, symptom control for confirmed or suspected COVID-19, or medicine unavailable from pharmacy.
All 813 independent care homes registered with the Care Inspectorate in Scotland were asked to complete an online questionnaire issued by Scottish Care in September 2020.
Responses were received from 106 care homes. The majority of respondents (76 percent) were aware of the guidance; however, only 19 care homes had used it.
- 18 of the 19 care homes reported having a healthcare professional on the premises when the guideline was used.
- All the care homes had used the guidance appropriately for residents in the following ways:
- 67 percent of times when patients required medicines urgently for end-of-life care
- 20 percent of times with confirmed or suspected COVID-19, requiring symptom control
- 13 percent of times when patients’ medicine was unavailable from the pharmacy
Repurposing medicines is a significant change of practice. Infrequent use of the guideline provided some reassurance that most medicines are available via normal routes. Respondents demonstrated a high level of awareness of the guidance which was used appropriately and almost always with the involvement of a healthcare professional.
The low response rate limits extrapolation of results to all care homes and further studies would benefit from increased response rate and refinement of questions around which medicines were repurposed. Confirmation that the guidance is no longer used, if withdrawn after the pandemic, may also be required.
The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.
Competing interest statement:
The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.