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The Case for Digital Medicines Management in Domiciliary Care

On her first day back after holiday carer Amelia is looking forward to visiting Margaret and telling her all about it. As she goes in she’s horrified to find Margaret collapsed on the floor. Amelia is worried as Margaret is in significant pain.

Amelia calls the ambulance. She looks for Margaret’s medicines administration record or ‘MAR’ chart – the paramedics want to know what medicines she’s been taking. Amelia notices that an extra 50mg dose of blood pressure medication has been added to Margaret’s chart in the last two days.

Amelia calls Kerry, her manager, to tell her what happened and mentions the addition to Margaret’s MAR chart. Kerry says Margaret’s son Andrew took her to see her GP Dr Shah and her meds had been adjusted. Kerry had asked lunchtime carer Michael to add the new drugs to the MAR chart ready for Kate the evening carer.

Amelia finds the recent prescription, looks again at the MAR chart and sees what happened. Dr Shah had intended to reduce Margaret’s blood pressure medication by prescribing 50mg tablets instead of – not in addition to – the 100mg ones. But for two days Kate the evening carer has followed the MAR chart and given Margaret the 50mg of blood pressure medication as well as the 100mg tablet. Kerry and Amelia realise this extra dose was probably the reason Margaret had fallen after getting up from her chair.

Amelia is very upset. Taking care not to breach client confidentiality she tells her friend Emma who works in local care home Meadowfields what happened that morning. “Thank goodness we now have a digital system here,” says Emma. “All meds are managed on our mobile device, not paper MAR charts. My manager uploads all the meds information and changes using information sent from the pharmacy’s computer. I put in the resident’s name and it just gives me the meds due at that particular time. I click to say they’ve been taken and that’s it. The system flags up anything that’s forgotten. A system like this really cuts errors and helps us meet the CQC key question about keeping people safe.

A few days later Andrew brings Margaret home from hospital. Amelia is pleased to see her but notices how much the hospital stay has affected her. She is much frailer and seems confused. Amelia wonders how much longer Margaret will be able to stay independent in her own home.

Between 2015 and 2019 CQC received 500,000 notifications of serious medicines errors, some involving death and serious injury. Digital medicines management is now a standard part of most care home software packages – but not yet in domiciliary care.

This is set to change because an LGA and NHS Digital project has just produced a specification for what’s needed so care commissioners can use this to ask software providers to develop it for their care providers and then support care providers to transition to digital meds management. By making this happen the future safety and wellbeing of Margaret and many more like her will be improved, as well as reducing the implications of errors for families, front line carers, care managers and care commissioners.

Get started by downloading the LGA/NHS Digital specification for digital medicines management at: https://www.digitalsocialcare.co.uk/resource/domiciliary-care-digital-medicines-support-specification/.