Positive Risk-Taking in Medication Management for Older People
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Medication management is one of the highest-risk areas in older people’s services and frequently becomes a driver for restrictive practice. Concerns about errors, non-compliance or adverse outcomes can lead to blanket controls that remove choice and independence. However, positive risk-taking recognises that supported medication autonomy can improve wellbeing, confidence and long-term outcomes when properly governed.
This article links medication management with positive risk-taking and quality and governance, focusing on practical delivery rather than theory.
Why over-control increases long-term risk
Removing all involvement in medication can reduce understanding, increase dependency and create distress. In some cases, it can lead to covert non-compliance, refusal or disengagement. Positive risk-taking reframes medication support as a partnership, not a control mechanism.
Operational example 1: Supporting partial self-administration
Context: An older person wished to retain control over morning medication.
Support approach: A capacity assessment and risk discussion were completed.
Day-to-day delivery: Medication was supplied in a monitored dosage system, with staff observing administration initially and reviewing weekly.
Evidence of effectiveness: No missed doses were recorded and confidence improved.
Operational example 2: Managing PRN medication safely
Context: Concerns existed about PRN pain relief use.
Support approach: Clear thresholds and recording expectations were agreed.
Day-to-day delivery: Staff supported decision-making and documented outcomes after each use.
Evidence of effectiveness: Reduced overuse and improved symptom control were recorded.
Operational example 3: Transitioning from full support to independence
Context: A resident regained dexterity following rehabilitation.
Support approach: Medication responsibilities were gradually stepped down.
Day-to-day delivery: Risk assessments were updated monthly during transition.
Evidence of effectiveness: Safe self-management sustained for six months.
Commissioner expectation
Commissioners expect medication support models that balance safety with independence and reduce avoidable care dependency.
Regulator expectation (CQC)
CQC expects providers to evidence capacity-based decisions, least restrictive practice and ongoing review in medication management.
Embedding positive risk in medicines governance
Strong services embed enablement within medicines policies, supervision and audits, ensuring staff confidence and consistency.
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