What is a medication audit?

The CQC is currently scoping a major review of medication management for residents in care homes. The common causes of medication risk and error are:

• Lack of staff competence and workforce capacity
• Poor prescribing, monitoring and reviewing
• Medication administration systems that are difficult to use
• Poor transfer of care
• Incorrect supply, storage & disposal of medication
• Delays in documentation

What is the purpose of a medication audit?

The Care Quality Commission is a public body of the department of health and social care. Their purpose is to inspect health and social care services in England to ensure the correct procedures are being followed.

The purpose of an audit is to ensure that the policies, care plans, medication management and other relevant documentation is in line with how policy states they should operate. Managers need to provide evidence that the staff are involved in measuring their level of service.

The process of medication auditing is to ensure that a care service avoids potentially fatal errors. A professional audit can be carried out at random during any time of the year, therefore it is imperative that the service operates as it states to avoid poor quality care to the residents.

Managers and staff of care homes often consider internal auditing to be a daunting task. It is not only time-consuming, but teams often suffer from a lack of knowledge of auditing and the right methods to use to identify errors.

However, when CQC inspect a care home and they see that regular audits are completed - and have produced either evidence of high-quality care or actions taken to address issues - they can see that care standards are taken seriously.

Completing a medication audit

When completing a medication audit the following things need to be thoroughly checked:

• MAR or eMAR sheets are to be completed correctly with initials, time, date, dosage (both prescribed and non-prescribed medication should be logged).
• The correct storage and stock management of medication.
• Evidence of the staff supporting residents with taking their medication who may have reduced mobility or mental capacity.
• Correct recording of medication errors or near misses.
• The safe disposal of medication.
• Adequate staff training on medication management

Managing medication

So, what is the correct procedure for managing medication in care homes? Firstly, care home providers should have a care home medication policy, which they review to make sure it is up to date and is based on current legislation.

Medication administering can be managed through a MAR sheet which ensures that the resident receives the correct medication on time. However, the purpose of this section is to outline the process of medication before it is administered.

eMAR and electronic medication systems can improve these procedures by minimising errors and automating a wide range of associated processes. For example, with an electronic system in place, the ordering and management of the stock can be linked to the pharmacy, taking away any risk of human error resulting in a resident going without their medication.

Take a look at this quick case study video from Erskine Veterans' charity, who operate care homes and nursing homes, explaining how they've benefited from the use of electronic medicine management:

 

Staff members should be appropriately trained in administering medication to minimise fatal errors to the residents. Effective use of MAR sheets and a clear understanding of the medication needed is imperative as a requirement in the Care Homes Regulation Act. 2001.

Care home staff should have consent from the resident when prescribing or administering medication. If a resident refuses to take medication, it should be properly logged with the reason why.

Care staff should also identify any hindrances such as mental capacity in residents in case they cannot give consent, as this may require assessing a person’s ability to determine their own care and giving medications without their knowledge. Read more on refusal of medication.

Taking control

Linking back to the risks medication management can produce, this is how you as a manager, can take control of your service and ensure that you are following the correct procedures which put the resident’s quality of care as the priority.

Reporting and learning from incidents.

Reporting incidents and near misses - and taking action to address them - is crucial to reduce the likelihood of the same error occurring again.

Supply, storage and disposal

Medication should be stored in a safe place away from the residents’ access to minimise risk. The correct temperature that a drug must be stored in should be maintained and checked regularly to ensure their effectiveness is not compromised. Medication should be disposed of in the appropriate manner. Finally, a stock management procedure should be in place to minimise the risk of residents not receiving crucial medication on time.

Prescribing, monitoring and reviewing

The appropriate professionals must be responsible for authorising the prescribed medication, monitoring the resident and reviewing their need for the medication.

Transfer of care

Finally, the correct management of residents who have been admitted into care homes from a hospital for long-term care, must be evidenced to ensure their safety and quality of care.

Time to learn more about medicines

Hopefully now you have a better understanding of why we do medication audits and the key areas you want to cover when you carry one out. 

If you're interested in improving medication audits, safety and overall management of medicine safety in your care service then you should read some of the guides we have available:

Medicine Errors: Causes, consequences and how to prevent them. Specifically for residential care settings, this is a very handy guide to keep by your side, to understand why medicine errors most often occur and what you can do to prevent them. 

And if you are considering, or unsure about eMAR and electronic medication management systems then you should read 'A Providers Perspective', this guide takes the real opinions of care providers that have used these systems and where they had problems, what they have achieved and their recommendations for people looking at similar solutions for their care or nursing homes