Wirral care home medication review leading to improved pharmaceutical care
Medicines wastage in England has been estimated to cost £300million each year. Of this, £24million is medicines disposed of unused by care homes. To tackle this, we decided to test the effectiveness of an intensive care home medication review.
One of our medicines optimisation pharmacists carried out an intensive medication review, working in a care home for five days. The home was selected because most of its residents were registered at one single medical practice. The pharmacist’s input gave clinical support to the GPs and care home staff and improved team working and communication. She started by talking to the home‘s staff and the local community pharmacists supplying it and by an electronic search on the GP clinical system, identifying 39 patients to be reviewed.
The pharmacist fully involved patients and carers in order to understand their experience 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.
Our 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.
Following an evaluation of the findings, work is currently ongoing to develop a more widely collaborative approach involving local community providers, secondary care and the CCG’s quality improvement team to spread best practice and improve quality of care for patients.
The pharmacist 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 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 benefits from the same.
Dr Edward Roche MB ChB MRCGP | GP partner and Care Home Lead, Marine Lake Medical Centre, W. Kirby