Summary of the example
The Central London Community Healthcare (CLCH) NHS Trust was commissioned to deliver improved proactive integrated care to care home residents. The project was commissioned across Hammersmith & Fulham and West London CCGs to improve care to approximately 1000 residents in 19 care homes ranging from nursing homes to Extra Care homes. This was a multidisciplinary project which showed the benefit and impact of pharmacists working within care homes.
Why we think it’s important
Seventy percent of care home residents experience at least one medication error. In addition 50% of medicines are not taken as prescribed, with adverse drug reactions contributing to 17% of all hospital admissions. A local review of London Ambulance Service (LAS) calls outs and audit of selected care homes showed inequity of provision and access to services.
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Aims and objectives of the work
The aim of the project was to standardise provision of care across the care homes, target causes of non-elective preventable hospital admissions, ensure a consistent skill set for staff through training and to support care homes staff in working in partnership with their residents’ family members/ informal carers to optimise care for their residents. Pharmacists worked within a multidisciplinary team and alongside care home staff and residents to achieve the shared goals.
Two Senior Band 8a Clinical Pharmacists provided proactive care through the following:
- Delivering proactive level 3 medication review including deprescribing and medicines optimisation
- Medicines reconciliation for all new residents and those recently discharged from secondary care to improve transfer of care.
- Supporting care homes to reduce medication errors
- Attending monthly multi-disciplinary team meetings and advising on medication
- Reducing medicines wastage
- Education and training of residents, carers and care home staff
- Supporting care homes in developing medication policies
- Working in partnership with the resident, care homes and all the relevant health and social care professionals across different sectors
Interventions were recorded on a database and graded using a tool adapted from King’s College NHS foundation Trust.
The project highlights the benefits of proactive care home pharmacists providing support to care homes. The preliminary results from December 2013 to July 2016 showed 9922 interventions were made for 981 residents, with 87% of interventions actioned by GPs; 213 of these were grade IV (reversible harm or admission to hospital) and 2 grade V (averted death or major permanent harm). A total net cost savings of £160k per annum was achieved by reduction in polypharmacy and implementing cost saving strategies such as switching to a cheaper alternative. Compared to 2014, there was a 22% reduction in LAS call outs and a 17% reduction in falls in 2015. Also positive qualitative feedback from care home staff, practices and residents was collected independently from the Collaboration for Leadership in Applied Health Research and Care North West London which showed the benefit of care homes pharmacists. Following the end of the project in West London and review of data, a pharmacist has been commissioned to continue the service.
Central London Community Healthcare NHS Trust. Poster: Proactive Care Homes Pharmacists
National guidance, data and publications
A prospective Care homes use of medicines study (CHUMS), found residents are at particular risk from medication errors and that seventy percent of care home residents experience at least one medication error. Another study on medication administration errors for older people in long-term residential care, reported that more than 90% of the residents were exposed to at least 1 potential medicine administration error. The NICE Quality Standards on Medicines Management in Care homes specifies to improve the safe and effective use of medicines by people of all ages who live in care homes, and that clear systems and processes are needed across the medicines management pathway. All health and social care professionals especially pharmacists have to manage these challenges and services should be commissioned from and coordinated across all relevant agencies encompassing the whole managing medicines in care homes pathway. The RPS document The Right Medicine: Improving Care in Care homes highlights professional leadership by pharmacists as part of a multidisciplinary team is the catalyst that is needed to make change happen. This in line with the five year forward view for the NHS.
Regional Medicines Information Manager, London Medicines Information Service