Care home residents typically have various day-to-day needs, from social interaction to support with food, drink and self-care, as well as the provision of medication.
Some pharmaceutical items will be simple to manage. Nurses and social care practitioners should assume that a resident can look after and self-administer their medication unless a risk assessment has indicated otherwise. However, some medications, such as controlled drugs, require dedicated storage and management which is the responsibility of the care home team.
Staff should be aware of the types of medication that fall under the title of controlled drugs and have knowledge of how to safely store these items. It is essential to recognise key pieces of legislation that the entire care home team can look to for guidance.
Controlled drug use in care homes
A controlled drug is a substance specified in the extensive lists that make up parts of the Misuse of Drugs Act 1971 (MDA) and the Misuse of Drugs Regulations 2001 (MDR). Care home staff are afforded protection when handling these products under the latter regulation.
It’s important to note that care homes without nursing support cannot hold stocks of controlled drugs, just the items that have been prescribed and dispensed for an individual person.
The MDR splits controlled drugs into 5 ‘Schedules’ which are referenced throughout the legislation. Rules surrounding the acquisition, storage, prescription and administration of each substance differ depending on the schedule.
Whilst the legislation features endless lists, some of the key pharmaceuticals of note from Schedule 2 include:
- Morphine
- Oxycodone
- Fentanyl
- Methylphenidate
Others from Schedule 3 include:
- Midazolam
- Pregabalin
- Gabapentin
- Tramadol
Schedule 1 drugs are not used medicinally, whilst most Schedule 4 and 5 drugs have typically more relaxed measures and control.
Schedule 2 pharmaceuticals must be stored in a controlled drugs cupboard unless a resident is responsible for the items themselves. A monitored dosage system may be given alongside it, and this will also need to be stored in a safe, locked cupboard.
Disposal of controlled drugs in care homes
Unwanted or out-of-date controlled drugs must be separated from available and usable stock items.
If a care home does not have nursing, the controlled drugs should be stored safely before being returned to a community pharmacy for destruction.
Care homes with nursing must denature drugs before they are passed over to a waste disposal company. A T28 waste exemption is required from the Environment Agency.
In line with Health Technical Memorandum 07-01 (HTM 07-01), the gold-standard waste management guidance document, care home staff should store waste pharmaceutical products in blue containers. The T28 waste exemption allows a care home to denature controlled drugs prior to disposal.
Choose high-quality solutions
Initial Medical, the expert waste management service, supports care homes with both Controlled Drug Denaturing Kits, available in various sizes with easy-to-use instructions, and pharmaceutical waste containers.
These include the small Eco Pharmi bins, which are manufactured from 100% recycled plastic and puncture-resistant and seepage-proof. The Eco Pharmi is available with a blue and purple lid for the safe differentiation of non-hazardous, cytotoxic or cytostatic pharmaceutical waste.
Care home staff must ensure they can safely store and dispose of controlled drugs. Those requiring more information should speak to a specialist waste management service.
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