Background

Having identified medicines-related issues at a nursing home, colleagues from Lancashire County Council requested support from MLCSU’s Medicine Optimisation Care Home (MOCH) team.

The objective was to help the nursing home to achieve the necessary standards through improved medicines management. This was to be achieved through tailored advice and training.

Action

The MOCH team began by undertaking structured medication reviews (SMRs) with carers for all residents of the nursing home. They also shared medication review feedback with the GP, the community pharmacist and the nursing home.

They attended quality improvement meetings with the Lancashire County Council and the GP.

All nursing home staff were given access to MOCH medicines training webinars, covering topics including:

• medicine administration
• waste management
• ordering & booking in of the monthly medication order

The team also provided medicines administration audit support, provision of advice on safe storage and monitoring of medicines and accurate documentation of care plans.

Impact

As a result of the MOCH team’s interventions over a 6 month period, 18 structured medication reviews were conducted for vulnerable residents of the nursing home. The majority (78%) of the patients were aged 75+.

A total of 69 interventions were made:

• 23 low impact interventions. This included stopping a controlled drug which was no longer being taken and was removed from the medicine administration chart.
• 39 medium impact interventions (moderate risk to patient safety). This included stopping an oral nutrition supplement in a patient who was becoming overweight.
• 7 high impact interventions (potential to cause significant harm to the patient). This included stopping a blood pressure lowering medicine in a patient who had low blood pressure and a history of falls and seizures.

Approximately 25% of the patients reviewed avoided potential significant harm as a result of the actioned recommendations.

The team achieved a total of 21 cost savings to the value of £376 per month or £4,892 over a year.

Through the reviews,14 medicines were stopped.

The work of the team resulted in improved ongoing communication between the GP practice and nursing home.

The nursing home progressed from being rated in ‘special measures’ to a status of  'overall improvement.’

The Medicine Optimisation Care Home team have done a great job in looking after our patients holistically via doing SMRs which were tailored to each individual patient’s needs, social and clinical background.

“Everything was explained thoroughly and backed with evidence which resulted in a high level of care for our patients and avoided potential hospital admissions or harm.

“Appropriate medicine training was provided to the care home staff.

“We greatly appreciated the support.”

Dr Mohamed Hassan |
GP Principal at Lytham Road Surgery, Preston