Medicines optimisation

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

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. 

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 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.

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.”