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Optimising prescribing for care home patients
Reviewing the medication given to patients in West Cheshire care homes improved patient care and resulted in savings.
There is a high incidence of medication errors in older people living in nursing and residential homes. Pharmacy technicians completing medications reconciliation, technical medication reviews and improving systems in care homes can help to reduce errors and harm to the patient.
The MLCSU Medicines Optimisation Technician (MOT) service in West Cheshire has been developed over the past 10 years and involves 43 care homes and 35 GP practices. Each home is visited by the MLCSU Medicines Management and Optimisation (MMO) care home technician on a rolling basis. Initially the patient’s practice records are reviewed – checking for any recent secondary care letters, medication compliance issues and outstanding blood tests.
During the visit, medicines reconciliation is completed where Medicines Administration Record (MAR) charts are compared to the resident’s GP practice record. The MAR charts are checked to ensure that they have been completed appropriately and any specific drug issues are identified and dealt with. Following the visit, recommendations made by the MOT are sent to the GP practice for action.
During 2016-17 a total of 1,176 patients were reviewed across 36 nursing and residential homes. This resulted in 7,195 interventions, and £94,050 of savings were identified for the year.
Common interventions included addition of missing drug reactions, quantity alignments, clarifying directions, reviewing medication and formulary choices to ensure most appropriate product is prescribed, highlighting overdue blood tests or late routine injections. We work closely with the CCG’s safeguarding team to raise safeguarding issues or concerns.
All findings are then discussed with the care home’s nurse or senior carer. Outcomes were shared with each home, GP practice and community pharmacy. The CCG and safeguarding teams as well as local authority and CQC were informed of findings.
Our practice provides care for more than 130 patients in four care homes. The Medicines Optimisation Technician provides an invaluable service reviewing these patients, checking blood tests… and suggesting optimal prescribing. They reinforce all local formularies. Our practice gains from reduced prescribing and the process of issuing monthly repeats due to fewer queries. The MOT works closely with all involved to ensure appropriate high quality care is delivered.
Branwen Martin, GP, Western Cheshire Clinical Commissioning Group
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