Free article: Medicines management: The benefits of pharmacists in care homes

Published: Thursday, 06 September 2018

Karen Parker, Regional Manager at Quantum Care, explains the not-for-profit care provider’s role in the recent NHS Vanguard pilot, and how the results will change how care homes manage residents’ medication needs for the better.

Summary

  • Research shows that, when a resident is taking multiple medications, there is a higher risk that they will fall or have an adverse reaction that may lead to a hospital admission.
  • Care homes administer large quantities of medication to residents but rarely have staff onsite who are qualified to prescribe medication or change dosages.
  • Pharmacists based inside a care home are able to work with residents to make sure the medications they have been prescribed are appropriate and remain beneficial to their health and wellbeing.
  • Pharmacists can support care staff to create better managements systems that reduce waste and inefficiency.
  • Pharmacists can also train care teams to better understand how to manage medicines and identify when a medicine is having an adverse effect on a resident.

Medications and health

With the average care home resident taking seven to eight different medications per day, the safe and effective management of these medicines is one of every care home worker’s most important tasks. But could the introduction of a community pharmacist to the care home environment help reduce the number of medicines residents take, and the time staff spend managing them?

Research shows that when a resident is taking multiple medications it can sometimes end up doing them more harm than good. The more treatments a resident is taking, the higher their risk of falling or having an adverse reaction that may lead to a hospital admission. Both are scenarios which cause discomfort for the individual and can create additional burdens for the NHS.

Uniquely, care homes administer large quantities of medication to the residents but rarely have staff onsite who are qualified to prescribe medication or make changes to dosages. Unlike hospitals or dentist practices, when a care home resident reacts poorly to their medication we must rely on a visiting GP to make their assessment before the problem can be fixed. And while GPs will always endeavour to visit our residents quickly, the fact they must take time out of their normal working day to travel to a care home can cause a knock-on effect on these already overstretched GP services.

Vanguard project

That is until now, with the introduction of a new NHS Vanguard project aimed at improving health and medication management in care homes, which has been trialled extensively across Quantum Care’s homes in East and North Hertfordshire.

As part of the pilot, pharmacists and pharmacist technicians were based inside our care homes and worked alongside GPs, care home staff and other healthcare professionals to provide comprehensive clinical reviews for residents. Staff were able to work with residents to make sure the medications they had been prescribed were appropriate and remained beneficial to their health and wellbeing. Pharmacists supported care staff to create better management systems that reduced waste and inefficiency, as well as introducing enhanced training to help care teams better understand how to manage medicines and identify when a medicine was having an adverse effect on a resident.

The pilot was incredibly successful. Within the care home I managed there was an annual saving of over £50,000 in medication costs due to pharmacists – in partnership with our care team and local GPs – cutting out unnecessary medications and identifying better alternatives. This is a significant saving for the NHS, but more importantly it enhanced the health and wellbeing of the people we care for.

Improving health and wellbeing

I personally saw how some of our residents, who had multiple prescriptions to manage comorbidity conditions, became more sociable, lively and happy after their medication review. They were able to join in activities that would have been too much for them only weeks before, their behaviour changed for the better and their mood improved. Put simply, these results alone were incredible, and justified the value of the pilot irrespective of the associated cost savings.

Indeed, across the six Vanguard areas taking part, the NHS found that having a pharmacist attached to a care home resulted in a 21% reduction in emergency hospital admissions, a 30% reduction in ambulance call-outs, and savings on medication costs of between £125 and £305 per resident.

As a result, NHS England has promised to fund the recruitment of 240 pharmacists and pharmacy technicians to work in care homes and build on the work that Quantum Care and everyone involved in the Vanguard project has already done to optimise medication management in care homes.

Integrating health and social care

This is the future of care delivery: integrating health and social care in such a way that carers and clinicians work together for the benefit of residents and the NHS. The national roll-out will take some time to implement, but while we wait, there is plenty that care providers and staff can do to optimise the way in which we manage medicines ourselves.

For example, at Quantum Care we have shared the findings across the company with a view to implementing the lessons learned in all 26 of our care homes. Leading this has been those staff trained by the pharmacists who have been strong advocates and have been sharing their newfound knowledge and skills with their colleagues. In my view, there is no reason why the care homes who took part in the NHS Vanguard trials shouldn’t be able to share this best practice and knowledge with other care providers to the benefit of us all.

Medication reviews

In this spirit, my best advice for those looking to get a head start in medicine optimisation is to make sure you block out time to hold regular medicine reviews alongside the local GP and pharmacist.

This is especially important for those residents who might be new, particularly those who have come from a homecare setting or who are living with dementia. During our participation in the trial we found that, under the guidance of the GP and pharmacist, we were more able to transition new residents away from some medications and towards the stability of routine and relaxation therapies – doing wonders for their mood, socialisation and well-being.

Finally, and with the above in mind, make sure you really examine the kind of relationships your care staff have with local pharmacists and the GPs, because the only way for medicine optimisation to work is if you have a professional working relationship in which everyone involved is respectful of each other’s expertise, experience and time.  Remember, you all have the same goal: to improve the happiness, health and well-being of the resident.

Toolkit

Use the following items in the Toolkit to put the ideas in this article into practice:

About the suthor

Karen Parker has been working within the social care sector since 1995. She began as a care-worker before working her way up to her current role as Regional Manager for Quantum Care, where she oversees the smooth running of nine care homes in Hertfordshire. Karen recently oversaw Quantum Care’s participation in the NHS Vanguard trial to optimise medicine management.

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