The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications. Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Pharmacist Interventions and Medication Reviews at Care Homes - Improving Medication Safety and Patient Outcomes, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Pharmacist Interventions and Medication Reviews at Care Homes (ARC Primary Care Network):
Improving Medication Safety, and Patient Outcomes.
Vaneeta Anand, Pharmacist, Fedbucks
Pharmacist interventions and medication reviews are critical for improving
medication safety and patient outcomes in care homes. Care homes are
home to elderly residents who are often on multiple medications and may
have complex health needs. This makes medication management a significant
challenge for healthcare providers
Role of Pharmacists in Care Homes: Pharmacists play a crucial role in
medication management in care homes. They are responsible for ensuring
that medications are prescribed, dispensed, and administered appropriately,
and that any potential medication-related problems are identified and
addressed promptly. They also work closely with healthcare providers,
including physicians, nurses, and other members of the care team, to
optimize medication therapy and improve patient outcomes.
Background
To examine the role of pharmacist interventions and medication reviews in
improving medication safety and patient outcomes in care homes.
Aims
Pharmacist interventions and medication reviews are essential for improving medication safety and patient outcomes in care homes. These interventions can lead to significant improvements in medication therapy
and reduce the risk of medication-related problems, such as falls, improve compliance and reduce cost and by streamlining the prescription, make the process efficient for the careers and nurses. There is evidence
that multi-disciplinary interventions are most likely to be effective in providing effective medicine reviews in care homes. Care homes should consider the inclusion of pharmacists in their care teams to ensure that
medication management is optimized and that patient outcomes are improved. In this instance the medication review was carried out as an MDT approach with the staff in charge and all changes approved by the
responsible GP.
It is essential to carry our Structured Medication Reviews (SMR) in care homes with nurses’ and carers’ in addition to the patient as they have the knowledge of their patients. The process was relatively easy as was
carried out at the care homes with access to all patient information including the main carer/nurse in charge.
In conclusion, nursing homes can reduce telephone calls to GP surgeries by improving medication management, scheduling regular health assessments, using care plan and support plans in a digital form..
.
Conclusions
Proposal Plan:
1. Situation, Background, Assessment, Recommendation (SBAR) form; Devise and implement a SBAR referral form (currently is underway).
2. Timely Medication reviews: Aim for annual review for all, following any admission or decline in health.
3. Communication: encouraging the care homes to corresponds with the PCN team via emails rather than phone calls. This would improve audit trail. Medication related issues are a common reason for care homes
to contact their GP surgeries.
4. Have a nominated pharmacy team for care homes.
5. Care homes to use the proxy system (currently is underway).
6. GP surgery to ensure the proxy system is set up for the care homes.
7. Regular Health Assessments: Regular health assessments can help identify potential health issues before they become more serious, reducing the need for residents to contact their GP surgeries. Currently,
residents have annual reviews and a review following any admission. Looking to set up Gold Standard Framework (GSF) training for care homes and SBARD will aid carers to flag up any residents who they have
concerns about.
8. Care Plans: incorporate medication reviews in the care plans, which can help care home staff understand each resident's specific health needs and preferences. By following the care plan, staff can help residents
manage their health conditions and avoid unnecessary visits to their GP surgeries. Provide the care plans in digital form for ease of accessibility; GSF training will aid this.
9. Technology: Technology can be used to support care home staff in providing high-quality care to their residents. For example, electronic health records can provide up-to-date information on each resident's health
status, medication regimen, and care plan. This can help care home staff make informed decisions about resident care and reduce the need for telephone calls to GP surgeries. Proxy access will allow care homes to
review patient record from the care home visit/ pharmacy input
10.Pharmacy team to work closely with the GP/Physician associate responsible for the care home.
11.Develop a plan and agree aim for the plan and agree with each new resident within seven Operational Days of admission to the home and within seven Operational Days of readmission following a hospital episode
(unless there is good reason for a different timescale).
12.Base plans on the principles and domains of a comprehensive geriatric assessment including assessment of the physical, psychological, functional, social and environmental needs of the person including end of life
care needs where appropriate (current care plans already capture the data to do this).
13.Draw, where practicable, on existing assessments that have taken place outside of the home and reflecting their goals; and make all reasonable efforts to support delivery of the plan.
Next Steps
Medication Management Protocol Overhaul: Implemented a revised medication management protocol, emphasizing
deprescribing and tailored medication plans. This resulted in a more patient-centered approach, minimizing unnecessary
medications and optimizing therapeutic outcomes.
• Implemented Medication Reconciliation:
o Established robust medication reconciliation processes during transitions of care (admission, transfer, and discharge).
o Ensured that accurate and up-to-date medication lists are maintained for each resident.
• Deprescribing Initiatives taken:
o Identified medications that may no longer be necessary or are contributing to adverse effects.
o Gradually tapered or discontinued medications under the guidance of healthcare professionals, particularly when the
benefits were outweighed by potential risks.
• Individualized Care Plans developed:
o Developed individualized care plans for each resident, taking into consideration their unique health needs and
preferences.
o Regularly updated care plans based on changes in health status and medication requirements.
Multidisciplinary Team Collaboration: Led initiatives to foster collaboration among multidisciplinary teams. This change
facilitated comprehensive patient assessments, leading to informed decisions on medication adjustments.
Results
A collaborative approach was utilised to ensure a well-rounded perspective
in determining the most relevant and impactful areas for intervention.
Engagement in open discussions with colleagues and stakeholders was
initiated. Healthcare professionals, including general practitioners (GP),
paramedics, physician associates, nurse, care home staff and where
necessary the geriatrician, specialist nurses (such as diabetes, Parkinsons
nurses) were involved. Healthcare team members were encouraged in open
communication and collaboration.
The pharmacist and pharmacy technician visited the care homes within the
ARC Primary Care Network (PCN) and reviewed the patients with the staff in
charge. Any issues with complex patients such as diabetics, Parkinson's
patients, were resolved on the day by seeking advice from the specialist
nurse/GP.
Pharmacist Interventions: pharmacist interventions were carried out the
residential care home, including medication reconciliation, drug interaction
monitoring, medication regimen simplification, and medication education
for patients and their caregivers. Recommendations to the healthcare
providers regarding changes in medication therapy, such as dose
adjustments, changes in medication regimens, or the addition or
discontinuation of medications were also provided.
Medication reviews were carried out and actioned by the pharmacist and
documented by the pharmacy technician into the patients GP records. This
was to ensure all changes were documented and actioned in a timely
manner. Any com-plex patients were referred to the GP in charge for advice
and actioned appropriately after discussion with the GP.
Methods
An expression of gratitude to Emma Bennett, Dr. M Johnson, Dr. J Layng, and Y Mudhoo for their invaluable support and assistance during the SMRs conducted in the care homes. Their collaborative effort was crucial
in enabling to conduct the SMRs efficiently and effectively within a timely manner. Without the MDT approach, such successful outcomes would not have been possible.
Acknowledgements
A conduction of a thorough analysis of patient cases and collaboration with
the team to identify prevalent polypharmacy issues were undertaken. The
decision-making process involved considering the impact on patient
outcomes and the feasibility of implementing changes within the healthcare
setting.
The need to streamline medication regimens to improve patient adherence,
reduce adverse effects, and enhance overall healthcare outcomes were
recognised. Polypharmacy in care home patients can have significant
implications for their health and well-being. Care home residents, often older
adults with complex healthcare needs, are particularly vulnerable to the
effects of polypharmacy.
Implementing changes in care homes to address polypharmacy requires a
systematic and ongoing effort. Regularly reassess and adjust interventions
based on the evolving needs of residents and the latest evidence-based
practices in geriatric pharmacotherapy.
Information
0 200 400 600 800 1000
Patients Reviewed
Medications Reviewed
Issues Identified
Actions Taken
Stopped Medications
Change of Medication/Dose…
Interventions made (across 3 care homes
within 5 days)