Medication reviews are an important part of safe care in a care home.
Many residents take several medicines every day. Some may have been prescribed years ago. Others may have been added after a hospital admission, a fall, an infection or a change in behaviour.
Over time, the resident's health can change while the medicine list stays much the same.
A medication review is an opportunity to step back and ask:
Does this person still need every medicine they are taking, are the doses appropriate, and are the medicines causing any problems?
NICE says people living in care homes should have multidisciplinary medication reviews, with the interval between planned reviews being no longer than one year. Many residents need them more frequently because of changing health needs, multiple medicines or safety concerns.
Families can often contribute valuable information, particularly when they know what the resident was like before a medicine was started or have noticed changes in alertness, mobility, appetite, mood or behaviour.
This guide explains how medication reviews work, what families can ask and which signs may suggest that a review is needed sooner rather than later.
What Is a Medication Review?
A medication review is more than checking whether the prescription list is correct.
NICE describes a structured medication review as a critical examination of a person's medicines designed to:
- make sure treatment is still appropriate;
- improve the benefits of medicines;
- reduce medicine-related problems;
- identify unnecessary treatment;
- agree decisions with the person where possible.
In a care home, the review should consider all medicines, not just tablets prescribed every morning.
This includes:
- regular prescription medicines;
- “when required” or PRN medicines;
- creams and ointments;
- inhalers;
- eye drops;
- pain relief;
- vitamins and supplements;
- over-the-counter medicines;
- complementary treatments.
The review should ask whether each one is safe, effective and still necessary.
Who Should Be Involved?
NICE recommends a multidisciplinary approach.
Depending on the resident's needs, this may involve:
- the GP;
- a pharmacist;
- care-home staff;
- a practice nurse;
- a specialist nurse;
- a community matron;
- other health or social-care professionals.
The resident should be involved as much as possible.
Family members or carers can also be involved where this is appropriate and consistent with the resident's wishes.
This matters because care-home staff may know what happens during medicine rounds, while relatives may notice broader changes.
For example, a family member might say:
“Mum used to be able to have a conversation in the afternoon, but since that medicine was increased she sleeps almost all day.”
That observation can be clinically useful.
A good care plan should also record relevant medication needs, monitoring and review arrangements.
How Often Should Medicines Be Reviewed?
NICE says the timing should depend on the individual resident's health and care needs.
The maximum interval between planned multidisciplinary medication reviews should be no more than one year.
But annual review should not be interpreted as “once a year is always enough”.
A review may be appropriate sooner if:
- a new medicine has been started;
- the dose has changed;
- the resident has had a fall;
- they have become unusually sleepy or confused;
- they have lost weight;
- they develop swallowing difficulties;
- kidney or liver function changes;
- they return from hospital with a different prescription;
- their behaviour changes;
- a medicine appears ineffective;
- they repeatedly refuse a medicine;
- side effects are suspected.
A medication review should therefore be viewed as an ongoing safety process rather than a once-a-year paperwork exercise.
What Can Families Ask About Each Medicine?
You do not need to know pharmacology to ask sensible questions.
For each medicine, it can be useful to ask:
- What is this medicine for?
- When was it started?
- Is it still needed?
- How do we know it is working?
- Could the dose be lower?
- What side effects should staff watch for?
- Does it interact with any of the other medicines?
- Does it require blood tests or other monitoring?
- Could it contribute to falls, confusion or drowsiness?
- What would happen if it were stopped?
These are not confrontational questions.
They are exactly the kind of issues a structured medication review is intended to consider.
Could Medicines Be Causing Falls or Drowsiness?
Yes.
Medicines are only one possible cause of falls, but they can make a significant contribution.
NICE's current falls guidance specifically recommends structured medication review to identify medicines that may increase fall risk and to consider adjusting them where appropriate.
Medicines associated with dizziness, low blood pressure, sedation or impaired balance can be particularly relevant.
Examples can include some:
- sleeping tablets;
- anti-anxiety medicines;
- antidepressants;
- antipsychotics;
- strong painkillers;
- blood-pressure medicines;
- medicines with anticholinergic effects.
This does not mean these medicines should simply be stopped.
Some are essential.
The question is whether the benefits still outweigh the risks and whether the dose remains appropriate.
If a resident has recently started falling more often, medication should be one part of the investigation. See our guide to falls in care homes and what families should ask.
What About “As Required” Medicines?
PRN medicines are prescribed to be given only when needed.
Examples might include:
- pain relief;
- laxatives;
- anti-sickness medicines;
- medication for anxiety or agitation;
- rescue treatment for specific conditions.
Families can ask:
- What signs tell staff that the medicine is needed?
- Who decides when it should be given?
- How often has it been used recently?
- Is it actually working?
- Are staff recording why it was given?
- What happens if it starts being needed every day?
CQC guidance says PRN plans should make clear which signs and symptoms staff should look for, what alternatives should be tried where appropriate and when the medicine needs reviewing.
If a “when required” medicine has effectively become a daily medicine, that should prompt a review.
What About Medicines Used for Distress or Behaviour?
This is an especially important area for families of residents with dementia.
Antipsychotic medicines can sometimes be used when a person with dementia is experiencing severe distress, hallucinations, aggression or behaviour that creates a risk of harm.
But they are not routine sedatives for making somebody easier to manage.
NICE says antipsychotics for dementia should be used at the lowest effective dose for the shortest possible time.
The need for treatment should be reassessed at least every six weeks.
Families can reasonably ask:
- Why was this medicine started?
- What behaviour or symptom is it intended to treat?
- What non-drug approaches were tried first?
- Has it actually reduced distress?
- Is the resident excessively sleepy?
- When was it last reviewed?
- Is there a plan to reduce or stop it?
If a medicine appears to be used mainly to keep a resident quiet rather than treat a clear clinical problem, that deserves further discussion.
Where there are wider concerns about unsafe or inappropriate care, our guide to safeguarding adults in care homes explains how concerns can be raised.
Why Timing Matters for Some Medicines
Some medicines need to be administered at a particular time.
A delay of 30 or 60 minutes may be unimportant for one medicine but clinically significant for another.
CQC identifies time-sensitive medicines as an important part of safe medication management.
Examples can include:
- insulin;
- antibiotics;
- medicines that must be taken with or before food;
- some pain medicines;
- Parkinson's medicines.
Parkinson's treatment is a particularly good example.
Giving medication late can cause worsening stiffness, mobility problems or difficulty swallowing in some people.
If your relative has Parkinson's disease, ask whether the care home records medication according to the person's prescribed times rather than simply fitting every drug into standard morning, lunchtime and evening medicine rounds.
Our guide to Parkinson's care homes and what families should look for covers this in more detail.
What About Swallowing Problems?
Difficulty swallowing becomes more common in frail older people and in conditions such as stroke, Parkinson's disease and advanced dementia.
A resident may start:
- holding tablets in their mouth;
- spitting them out;
- coughing when taking them;
- refusing large tablets;
- struggling with fluids.
Families may understandably suggest crushing tablets.
But care staff should not simply crush medicines without checking.
Some tablets are designed to release slowly, resist stomach acid or work in a particular part of the digestive system.
Crushing them can make treatment ineffective or unsafe.
A pharmacist or prescriber may instead recommend:
- a liquid version;
- a dispersible tablet;
- a patch;
- a smaller tablet;
- another medicine entirely.
The medication review should include problems the resident has taking medicines, including swallowing difficulties.
Who Decides if a Resident Cannot Make Their Own Medication Decisions?
A dementia diagnosis does not automatically mean that somebody cannot make decisions about medicines.
Mental capacity is decision-specific.
A person may be able to understand and decide about one treatment but not another.
If the resident lacks capacity for a particular medication decision, professionals must follow the relevant mental-capacity law and make decisions in the person's best interests.
Family members may have an important role, but being someone's son, daughter or spouse does not automatically give legal authority to make all medical decisions.
A health and welfare Lasting Power of Attorney may have relevant authority depending on the circumstances.
Our guide to power of attorney and care decisions explains this in more detail.
Covert medication — hiding medicine in food or drink without the person's knowledge — requires particular care and should not simply be used because a resident refuses tablets.
It should only be considered within an appropriate capacity and best-interests process.
When Should Families Push for an Earlier Review?
You do not have to wait for the next scheduled annual review if something has changed.
Ask the care home to contact the relevant clinician if you notice:
- a sudden increase in sleepiness;
- repeated falls;
- new confusion;
- significant constipation;
- poor appetite or weight loss;
- new tremor or stiffness;
- difficulty swallowing tablets;
- frequent vomiting or diarrhoea;
- new urinary problems;
- repeated medicine refusal;
- a PRN medicine being used very frequently;
- a major behavioural change after a medicine was started or increased.
These symptoms do not prove that medication is responsible.
But they provide a reasonable reason to ask whether medicines could be contributing.
Families can also ask when the last formal medication review took place and when the next one is planned.
What If You Are Not Happy With the Answers?
Start by asking the care-home manager or senior nurse for clarification.
You can request a discussion about:
- the medication care plan;
- recent GP or pharmacist reviews;
- recorded side effects;
- missed doses;
- PRN administration;
- recent medication changes.
Remember that confidentiality rules still apply.
If the resident has capacity and does not want information shared with relatives, professionals generally need to respect that.
If concerns remain unresolved, the next step depends on the issue.
A clinical concern may need discussion with the GP or pharmacist.
A care-quality concern can be raised through the home's complaints process.
Our guide to care home complaints and escalation explains the process.
If you believe medication is being administered dangerously, deliberately withheld, used as inappropriate restraint or otherwise placing someone at risk, the issue may also become a safeguarding concern.
Frequently Asked Questions
How often should care-home residents have a medication review?
NICE says the frequency should depend on the resident's needs and safety, but the interval between planned multidisciplinary reviews should be no longer than one year. Many residents need reviews more frequently.
Who carries out a medication review in a care home?
The review may be led by a GP, pharmacist or another suitable health professional and should involve a multidisciplinary team where appropriate.
Can family members attend the medication review?
Yes, where appropriate and consistent with the resident's wishes. NICE specifically includes family members and carers in medication reviews when appropriate.
Can I ask why my relative takes a particular medicine?
Yes, provided information can appropriately be shared with you. Understanding what each medicine is for is a reasonable part of medication review and care planning.
Can a care home stop medication without asking a doctor?
Care staff should not independently stop prescribed treatment unless they are following clear authorised instructions or an appropriate clinical plan. Concerns about a medicine should be escalated to the prescriber or relevant healthcare professional.
What is polypharmacy?
Polypharmacy simply means taking multiple medicines. It is not automatically bad: some people genuinely need many treatments. The concern is inappropriate polypharmacy, where medicines may no longer be necessary, beneficial or safe together.
Can medicines cause confusion in older people?
Yes. Some medicines can contribute to confusion, sedation or delirium, although infections, dehydration and many medical conditions can cause similar symptoms. Sudden confusion should be medically assessed rather than automatically blamed on medication.
Can medicines increase fall risk?
Yes. NICE recommends medication review as part of falls prevention because some medicines can cause dizziness, sedation or low blood pressure.
Should antipsychotics be used for dementia?
They may be appropriate in selected cases involving severe distress or risk of harm, but NICE recommends the lowest effective dose for the shortest possible time and reassessment at least every six weeks.
Can care homes give sedatives to make residents easier to manage?
Medicines should be used for a legitimate clinical reason, not simply for staff convenience. If you are concerned that medication is being used primarily to control behaviour or restrict a resident, ask for the clinical rationale and review arrangements.
What does PRN mean?
PRN means a medicine is given “when required” rather than at a fixed daily time. There should be clear instructions explaining when it should be used and how staff know whether it has worked.
Why does Parkinson's medication need to be given on time?
Some Parkinson's medicines are highly time-sensitive. Delays can lead to worsening movement, stiffness and other symptoms, so administration should follow the individual's prescribed schedule.
Can tablets be crushed if someone cannot swallow?
Not automatically. Some tablets must never be crushed. A pharmacist or prescriber should advise whether the formulation can be altered or whether a different preparation is needed.
Can a care home hide medicine in food?
Covert medication requires a proper legal and clinical process when a person lacks capacity to make the relevant decision. It should not simply be done informally because someone refuses treatment.
What should I ask at my parent's next medication review?
A useful starting point is to ask what every medicine is for, whether it is still needed, whether the dose remains appropriate, what side effects are being monitored and whether any medicines could be contributing to falls, drowsiness, confusion, constipation or other current problems.
