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Reviewing care home medication

 

Our pilot care home medication review resulted in greatly improved pharmaceutical care for patients, direct cost improvements and potential prevention of unnecessary hospital admissions.

 

Background

Medicines wastage in England has been estimated to cost £300million each year (Evaluation of the Scale, Causes and Costs of Waste Medicines, York Economic Consortium and University of London, 2010). Of this, £24million is medicines disposed of unused by care homes. Evidence shows that involving a pharmacist reduces medicines waste and emergency hospital admissions, and most importantly improves the quality of life for care home residents through better health outcomes.

Action

We tested the effectiveness of an intensive medication review by a pharmacist working in a care home for five full days in August 2017. The care home was selected because most of its residents are registered at one single medical practice. This improved time efficiency.

The pharmacist’s input gave clinical support to the GPs and care home staff and improved communication and team working. She started by talking to the care home staff and the local community pharmacists supplying the care home and by an electronic search on the GP clinical system, identifying 39 patients to be reviewed.

The pharmacist fully involved patients and carers in the process in order to understand their experiences of taking particular medications. A thorough general review included, for example, checking suitability and quantities of medications, dressings, creams and catheters, and scrutinising prescription anomalies. A clinical review identified areas of clinical impact and intervention which were discussed with the GP.

Impact

Our pilot care home medication review resulted in greatly improved pharmaceutical care for patients through various clinical interventions, reducing medication errors and adverse effects with the potential of preventing unnecessary hospital admissions. There was an immediate direct cost improvement of £10,728 annually due to medicine optimisation and waste reduction, as well as any resulting from preventing unnecessary admissions or further treatment.

Other benefits included:

  • A review of side effects led to doses or medication being optimised
  • Inappropriate sip feeds and laxatives were no longer used
  • Ordering of no-longer-required or inappropriate quantities of dressings, creams and catheters stopped
  • Drug and inhaler compliance issues were discussed with patients, care home and practice staff
  • Antibiotics were used appropriately
  • Appropriate therapy was recommended for patients at risk of fracture and falls
  • Unmet need and untreated atrial fibrillation were identified.

This project originally involved working closely with the care home and GP practice. Following an evaluation of the findings, work is currently ongoing to develop a more collaborative approach involving local community providers, secondary care and CCG quality improvement team to spread best practice and improve quality of care for patients.

I worked with [the pharmacist] during her time with the practice. She did detailed medication reviews on the residents in a nursing home as a result of which we are able to make some significant and sensible changes to many patients repeat prescriptions.

The support and guidance of a community clinical pharmacist is vital to the ongoing safe and sustainable care provided by GPs to care home residents and more importantly, from my perspective as a GP with special interests in working with care homes, a proactive multidisciplinary team approach to care home residents is fundamentally changing how the care home population is viewed by the healthcare sector…

The benefits of working with the clinical pharmacist were many, including working to local/national/recent formulary guidance, safe prescribing, medicines rationalisation and minimising the risk of adverse drug reactions and reducing waste. The whole system can benefit financially from fewer prescriptions, the patient benefits from reduction in potential side effects and drug reactions/interactions, the GP benefits from reduced workload created by polypharmacy and the care home benefit from the same.
Dr Edward Roche MB ChB MRCGP – GP partner and Care Home Lead for at Marine Lake Medical Centre, West Kirby