We are concerned with the care of patients of a 52-bed charitable care nursing home in Oxford. Over the last 9 months the home has been in dispute with a regulatory body, the Commission for Social Care Inspection (CSCI, formerly the National Care Standards Commission), over criticisms of our medicines administration system. The home works to the usual model of an NHS hospital in which a patient's Medicines Administration Record (MAR) chart functions as the definitive record of current prescriptions. The MAR is intended, where necessary, to override whatever may have been written on the label of the original medicine container. As in NHS hospitals, all medicines are administered to our patients by professionally qualified nurses.
In prescribing for ill older people dosages often need adjustment and discrepancies arise between the MAR and container labels. Initially the inspectors demanded that in such circumstances the label on each bottle or box should be altered to match the MAR. We had to point out to them that, legally, no-one is allowed to alter the label on a medicine. They then suggested that when a dosage is adjusted, the medicine should be returned to the issuing pharmacy for redispensing. This would require a new prescription, a redispensing of the medicine, and a further delivery from the pharmacy. This would involve a nonsensical waste of money and staff time and, most importantly, leave a patient without a necessary medicine until new supplies arrive.
Such proposals could only have come from people with great respect for the written word but limited awareness of the realities of providing drugs accurately and responsively to older people in nursing care. Is this a local phenomenon or are nursing homes elsewhere in the country suffering similarly? Worryingly, it seems that, like too many regulatory bodies, the CSCI is non-accountable for its competence and good sense — or lack thereof.
- © British Journal of General Practice, 2004.
