Clinical Indications in Care Homes and on MAR Charts

How does an indication reach a care home?

It travels with the prescription. Dr Masters’ FAQ 15 (2006) follows the prescription pathway to its final long-term destination, often the labelled medicine boxes in the patient’s home. The steps are:

1. In hospital, the prescribing doctor records the use in the clinical record and makes sure the hospital pharmacy uses clinical indications in the same way.
2. In primary care, the practice computer captures the indication.
3. The local pharmacy computer captures it next.
4. If the patient lives in a home where care staff are involved, the indication goes on the MAR.
5. Otherwise it goes on the label of the medicine package in the patient’s home.

FAQ 15 says “all these processes are important”, and that the route can be checked by departure and destination audits.

What is a destination audit?

A check that the indication has arrived where the medicine is used. For primary care, Dr Masters’ audits page (April 2006) describes checking the medicines management listings at nursing or residential homes, and FAQ 7 describes checking the drug charts at nursing homes.

It pairs with a departure audit at the surgery, which checks repeat scripts against a standard of 80%. A practice starting out should tell its local care homes: it is courteous to let them know. See GP practices.

What did the residential home audit find?

Nine in ten medicines carried their indication. In 2006, Highfield Surgery visited a residential home for people with learning disabilities; the residents were the surgery’s patients. It had six residents, with 52 prescribed medicine items between them, supplied through the Boots medicines system.

Forty-seven of the 52 items had their indication listed, a coverage of 90%. The unlabelled items included nutritional products and paracetamol.

What else can the prescription line carry?

Safety messages as well as the reason. FAQ 5 gives examples such as “regular three monthly blood tests required”, “yearly blood pressure check required” for the contraceptive pill, and a stop date for time-limited medicines. The Sample Directory includes warning messages too, because clinical indications “were designed to help health staff and patients get the best from their medicines”.

How does it help carers?

Carers can see what each medicine is for. The home page says: “Carers can quickly identify important drugs and reassure confused vulnerable patients.”

When clinical indications won the BUPA Communication Award in 2005, Dr Andrew Vallance-Owen of the BUPA Foundation said that many older people can be on ten different medications, and “it is easy for them or their carers to become confused about what each medicine is given for. Indication labelling spells it out for them.”

FAQ 7 adds that lists of indications linked to repeat prescriptions give “a rudimentary active patient summary list”, useful out of hours to emergency staff and to other visiting medical staff.

What about privacy in a shared home?

Others may see the indication. FAQ 4 notes that pharmacists record it with the directions, so packages left visible in shared accommodation could be seen by others. Some indications cover sensitive issues, and patients should be asked whether they agree; those who prefer not can have “patient preference no indication” instead. See for patients and carers.