Our medicines management and optimisation team improved safety and care for elderly Wirral care home residents, helped to prevent falls and hospital admissions, and saved costs.

Background
Nationally, care home residents take an average of 7.2 medicines each day. With each additional medicine comes an increased risk of prescribing, monitoring, dispensing and administration errors, adverse drug reactions, impaired medicines adherence and compromised quality of life for patients (Royal Pharmaceutical Society – The Right Medicine: Improving Care in Care Homes. February 2016).

Action
A team of pharmacists (equivalent to 1.5wte) were commissioned from NHS Midlands and Lancashire’s Medicines Management Optimisation (MMO) team for two years using NHS England funding via the Medicines Optimisation in Care Homes (MOCH) scheme. The aim was to support Wirral care homes for the elderly to improve medication and health outcomes, improve patient safety, improve processes, reduce inefficiencies and reduce waste. The team:

• Delivered medication reviews and completed medicine reconciliation
• Supported care homes to reduce medication errors and develop medicine policies
• Attended multi-disciplinary team meetings and advised on medication
• Educated and trained care home staff and residents
• Completed waste audits and advised regarding waste reduction.

Impact
The project resulted in improved safety and care for elderly Wirral care home residents and also provided support during the COVID-19 pandemic.

• 1,319 medication reviews and 146 medicines reconciliations were completed over the two year period resulting in 5,338 medication interventions and a cost improvement of £159,654
• Residents and care staff were helped to understand medication regimes to reduce the risk of medication errors or adverse drug reactions and potentially avoid hospital admission
• 443 interventions were deemed to have prevented a possible hospital admission saving £494,720 in admission costs
• Rationalisation of medication regimes led to a reduction in medicine administration time for staff
• Team support ensured prompt access to medicines such as those for end of life care
• Advice following waste audits saved £3,714
• Falls prevention support led to an improvement in the referral process for falls assessment that should reduce the risk of falls and hospital admission.

From the falls prevention perspective we find that the root cause of falling is often a case of combined side effects of polypharmacy, drugs that have been prescribed over long periods of time that are either no longer effective or doses are too high. I found our joint working very beneficial. For us, it enabled residents who were falling, whose risks had not been addressed by the home but identified by you, to be referred to us. It allowed us to highlight to you our concerns about medications, particularly those with high ACB scores which are known falls risks. Between us we were then able to inform the Quality Improvement Team who arranged a visit to the home. When assessing care home residents for falls risk, we find medication issues to be a common risk factor which can be resolved with medicines optimisation; so an important outcome of your work will be falls reduction. I really hope that your service is recommissioned because the benefits are more widespread than just the optimisation of medicines and it plays a key role in improving the quality of life, care and safety of care home residents and improving the working knowledge of other teams involved with care homes around medicines management.
Julie Griffiths, Wirral Falls Prevention Service Manager