NHS Norfolk Medicines Management in Care Homes Sue Woodruff Senior Clinical Pharmacist Co-ordinator (care homes) susan.woodruff@nhs.net
Background Almost 400 care homes in NHS-N area Care for over 8000 people with a wide range of needs 1990 s - Community pharmacies were funded to provide advice to care homes on storage & administration Funding withdrawn circa 2000 - PCT s wished for a more comprehensive service limited work commenced in West & North Norfolk
Background (cont d) Work extended when PCT s reconfigured in 2007 Medication reviews seen to identify savings in prescribing As progressed focus has become more about quality of prescribing Focus areas e.g. anti-psychotic use in dementia
The Team Clinical pharmacists Senior Medicines management technicians Also work in GP practices providing prescribing support
Aim of care homes work to visit Care Homes (registered with CQC) on a regular basis to provide Medication reviews for residents Medicines Management advice to care home staff Information resource for homes between visits
Process Technicians gather relevant patient information (medication, PMH, laboratory results etc) from GP practices Pharmacist & technician review forms & request further information if needed. Visit to home review with individual residents and / or care staff
Process cont d Face to face discussion with GP or written care plans Agreed changes implemented on practice system & read-coded Written feedback to home Interventions summary & cost savings recorded on database
Process cont d Medicines management checklist & CD checklist completed with care home staff Feedback to home on areas for improvement/ compliance with CQC requirements
Common interventions Medications stopped/ added Obsolete repeat items deleted Dose changes Quantity changes Formulation changes Blood tests ordered Switches in line with PCT policy
In 2009-10 we:- Visited almost 100 homes Reviewed medication of 1729 people Made 4026 interventions Made quantifiable savings of 120K
Growing focus on quality patient with dementia taking quetiapine (repeat Rx) & risperidone (regular acute Rx's) - not aggressive, but frustrated due to scabies itch drawn to attention of GP & both stopped - reduced stroke risk, less sedation, reduced falls risk Patient taking meptazinol since fracture 1 year ago - no longer had pain, didn't know what medication was discussed with GP & stopped - reduced sedation, reduced falls risk, un-necessary medication stopped
Benefits to patients (service users) Reduction in unnecessary / inappropriate medication Reduction in side effects Alternative dosage forms Information / improved understanding of medications Possible avoidance of hospital admissions
Benefits to staff Improved safety in medicines handling Easily accessible source of advice Support in meeting CQC requirements/ recommendations Improved communication with GP practices/ supplying pharmacy Reduction in unnecessary medication streamlined drug rounds
Benefits to PCT Reduction in medicines waste Cost savings Improved patient safety Reduction in avoidable hospital admissions Improved liaison / joint working with CQC and ASS staff
Antipsychotics/ dementia project Multidisciplinary project to reduce use of antipsychotic medication for behavioural symptoms of dementia particularly PRN Good practice guidance & self assessment tool for homes Prescribing guidance for GP s Training module -person centred approach & pitfalls of medications Further work to do (Bannerjee)
Further work Continue cycle of visits to homes Extend to Housing with Care Database of quality interventions under development User satisfaction survey UEA 4 th year undergraduates Support for ASS in review of medication policy Develop & widen Antipsychotics/ dementia project
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