Pharmacy staff from both hospital and primary care settings can play a key role in reducing potential harm to care home residents through ensuring optimal medicines management.
Pharmacists can take actions which can reduce the fragmented and unsafe care that leads to inappropriate prescribing and patient harm. For example, proactive medicines optimisation to ensure prescribing is “right first time”, challenging poor systems, deprescribing where appropriate, and ensuring residents are given an equal say in their care. In addition, we can help ensure that integration of care and shared decisions are happening across all organisations, involving both residents and their families. We can stratify risk to focus on patients with the greatest need and use improvement models to implement change.
Pharmacists can take actions which can reduce the fragmented and unsafe care that leads to inappropriate prescribing and patient harm.
There are various ways that residents in greater need of medication review can be identified. These include recent hospital admissions or new admissions, and recent or frequent fallers. In addition, patients on multiple medications, and those on ‘high-risk’ medicines such as NSAIDs, diuretics, ACEIs, digoxin, anticoagulants, antiplatelets, amiodarone, antipsychotics, opioids, antidepressants, hypnotics, anticholinergics, DMARDs and insulin. The calculation of anticholinergic burden scores can also help.
The process of medication review in a care home should include access to MARS charts, care plans, GP electronic records, other healthcare professionals, liaison with the resident and their family, and meeting with the GP to agree a plan of action.
As well as improving quality of care, there are also potential cost savings. Data from one NHS Community Trust demonstrated cost savings of £195 per resident per year as a result of face-to-face level 3 medication reviews and a waste avoidance saving of £507 per care home per year.