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Medicines optimisation

Care home residents take an average of 7-8 different medicines a day and medication errors are common

Care home residents take an average of 7-8 different medicines a day and medication errors are common.

In east and north Hertfordshire, as part of our NHS ‘vanguard’ project, clinical pharmacists are working with GPs, care home staff and other healthcare professionals to provide in depth clinical reviews for residents. Improved IT means they can access patient records in the care home, allowing a more thorough review alongside the resident’s medicines administration record (MAR) and care plan. 

Care home nurse on drugs round wearing 'Do not disturb' tabard.Any agreed changes are communicated with the usual supplying community pharmacy and where appropriate discussed with the resident or family members. Vanguard care homes within the East and North Hertfordshire Clinical Commissioning Group are each aligned to a single GP practice, which means a beneficial working relationship can be developed between GPs and aligned pharmacists. 

The care home pharmacist also carries out audits in homes identified as having medicines management issues.

Puja Vyas is one of four clinical pharmacists working on the project. She has regular meetings with GPs, care/nursing home staff and patients (if they are well enough) to review their medications.

“We talk about symptoms and the effects of their medication and sometimes we request blood tests to assess the effects of long term medications which they perhaps don’t really need any more,” she said.

Puja, who has been a pharmacist for 10 years, gives an example of a patient who was taking a proton pump inhibitor prescribed for use alongside a non-steroid anti-inflammatory, which she was no longer taking. Other reviews might include medicines that could be a factor in causing falls.

Part of the ‘vanguard’ project involves up skilling care home staff to better understand complex care needs.One of the training strands is nutrition and Puja says she has seen some excellent examples of this new knowledge helping in the reduction of medications.

“At Stanborough Lodge, Welwyn Garden City, one of the homes I visit, the nutrition champion has created fortified smoothies to replace costly nutritional supplements for some residents and laxatives for others. This is showing really good results in their health and wellbeing.

“This is a completely new way of working for us and it is proving to be really beneficial in lots of ways. Sitting down with the GP, carers and complex care champions in one room is extremely valuable and we are achieving positive outcomes really quickly.

Beauty Maruta, manager of Stanborough Lodge echoed Puja’s views.

“Our nutrition champion has helped us make worthwhile changes for residents. Previously if a resident wasn’t eating we would ask the GP for nutritional supplements. Now we make our own shakes and give them to residents between meals. Some even make their own as part of activity sessions.”

All 24 residents had their medications reviewed in Stanborough Lodge’s first joint meeting with its dedicated GP, Dr Shona Hyde from Peartree Lane Surgery, Puja and staff.

“Some medication has been stopped and we’ve also been able to reduce the amount we were ordering,” said Beauty.

“Some residents, for instance only take their paracetamol in the mornings, even though it has been prescribed several times a day. Now we are ordering to meet patient requirements, which we couldn’t have done before the review. It’s also saving the NHS money.”

Dr Hyde a GP aligned to a care home, praised the new way of working saying: “The opportunity to spend protected time focusing on individual patients is very beneficial. We went through every single patient’s medication and Puja contributed some very useful suggestions.

“When someone comes into a care home as a new patient it can take time to get to know them and their medications so these meetings are useful and valuable.”

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