Covid-19 - Summary for Medicines Re-use Scheme during the Pandemic
In response to additional demand for end of life medicines, a guide to medicines reuse for care homes and hospices has been published, which will help to ensure people get the medicines they require in their hour of need. The new guidance, published by DHSC, supports care home and hospice providers and offers a framework to run a safe and effective medicines reuse scheme that is in the best interest of patients.
CCGs have also been asked to work with providers to establish local hubs to ensure rapid access to end of life medicines for patients. These hubs could be community pharmacy, GP practice, community hospital, acute or other settings where palliative medicines (including controlled drugs) can be safely and legally stored and rapidly released when needed.
This is time limited and would only apply during this period of emergency. i.e. during the COVID-19 pandemic.
It is recommended that the guidance in full is referred to for the avoidance of any doubt.
Each individual care home or hospice must carry out a risk assessment on an individual medicine basis.
What might constitute a crisis?
Three key indicators should inform the risk assessment and the subsequent decision:
- 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.
- 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.
- 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.
Re-used medicines may be administered to residents in a care home or hospice under the direction of a prescriber, and in line with the SOP for running a medicines re-use scheme in a care home or hospice setting, and where an appropriate medicines re-use scheme is in operation.
Tables 1 to 3 below provide supporting prompts to assist the registered healthcare professional with their decision making. It is advised that medicines for re-use are proactively assessed prior to them being needed in an emergency situation.
Table 1: Criteria to be considered before the medicine can be reused
Is the medicine in an unopened pack or blister that has not been tampered with?
In an unopened, unadulterated and sealed pack (including sub-pack or blister strip.
If any doses have already been used, the remainder of that blister strip should be destroyed. If the contents (including blister strips and sealed individual units such as ampoules) are completely intact, then as long as they match the description on the packaging they were retrieved from (including check of batch numbers) they can be considered for re-use.
|Is it in date?||Medicines should be in date. If expired, they will need to be returned to a pharmacy to be safely destroyed.|
|Has it been stored in line with the manufacturer’s instructions, including any need for refrigeration?||Any medication that requires refrigeration, or that has a reduced shelf-life once removed from refrigerated storage, should be destroyed if it has not stored appropriately. Medicines left in unsuitable conditions (eg direct sunlight, near radiators) or where appropriate storage cannot be confirmed, should be destroyed.|
|Is the medicine a licensed medicine that has either been prescribed by a registered healthcare professional with prescribing rights or bought ‘over the counter’?||For some medicines, "homely remedies" are an option in care homes and should be considered in line with guidance: https://www.sps.nhs.uk/articles/rmoc-guidance-homely-remedies/
If the answer to all of the above questions is yes, then the risk of reuse may be judged to be minimal. If the answer to any question is no then the medicine should not be re-used. If doubt remains, discuss with appropriate registered healthcare professionals and local networks to get a wider perspective on the decision
Table 2: Minimise risk of cross-contamination
|Is the medicine from a patient with a diagnosis of COVID-19 or showing symptoms of COVID19?||Ensure that adequate infection prevention and control precautions have been taken. Medicine that has been retrieved from a patient infected with COVID-19 should be sealed (double bagged) and quarantined for three days. A do not process before date should be fixed to the bag before the bag is stored safely and away from any other medicines.|
Table 3: Ensuring permission is obtained and patients, families and/or carers are fully involved
|If a medicine is thought to be suitable for re-use, permission should, if possible, be obtained for reuse from the patient for whom it was prescribed or (if the patient lacks capacity) from a person with power of attorney, or (if the patient has died) from their next of kin.||If the patient has become responsible for the safe keeping of the medicine, it is the property of the patient (although not their exclusive responsibility), but if the medicine is still in the safe custody of the care home or hospice care provider, whether the final supply to the patient has been completed is the subject of differing legal views. Reflecting this uncertainty, if possible, ensure the patient or their next of kin agrees for the medicine to be reused. See Annex B .|
To ensure re-use of medicines is an option that can be used as flexibly as possible we suggest that care homes and hospices proactively seek written permission from all patients for:
- their medicines (if no longer needed) to be made available for other patients and/or
- them to receive a re-used medicine, provided they are deemed safe for reuse.
Unless the product is being supplied under a PGD or a patient specific direction, a new prescription must be obtained prior to supply to the new patient. If it is for a controlled drug, the extra requirements in relation to controlled drugs prescriptions must be satisfied. New remote prescriptions should be scanned and emailed before the first dose is given, and a copy of the prescription kept with the patient’s records in line with current processes.
Further information to inform discussions is available in Annex B of the main document.