Medication review in care homes optimise care and deliver efficiency savings

Clinical care home pharmacists from NHS Leeds West Clinical Commissioning Group (CCG) have been improving disease management and reducing medicine waste in care home patients as part of a pharmacist-led project.

The Care Homes and Medicines Optimisation Implementation Service (CHAMOIS) was initially developed as a 12 month pilot in August 2013 but its successful implementation has led to a further 12 month extension for the project.

Clinical care home pharmacists provide holistic patient-centred medication reviews for patients who live in care homes in the area of Leeds covered by NHS Leeds West CCG. This takes in 80 care homes spread across 38 GP practices, with around 1,600 patients eligible for the service.

Since the project launched the CHAMOIS scheme has delivered a net saving of £80,000 for the CCG. It has also helped ensure patients are on the most appropriate care pathways reducing the risk of unnecessary admission to hospital and medication errors.

To help healthcare professionals and the wider public understand how the care home medication reviews help patients, the project team has created a short animation featuring a fictional patient called Doris. The video shows how patients, like Doris, can benefit from the support offered by the clinical care home pharmacists.

Helen Whiteside and Nicola Shaw, Clinical Care Home Pharmacists for NHS Leeds West CCG, said: “The project has been really beneficial to care homes, as we have stopped medicines for some patients that were causing them side effects and that means patients are more alert, they can socialise more in care homes, have a better appetite and generally they are feeling much better. Side effects that we have prevented will stop patients from going to hospital so we’ve reduced the number of hospital admissions.

“The review has delivered the CCG gross savings of £100,000 and from that we have spent £20,000 on improving and changing patient’s medication.”

Dr Andrew Sixsmith, GP at Thornton Medical Centre, said: “I have an overarching responsibility of two care homes and I’m assured that patients are getting a thorough medication review by a clinical care home pharmacist.

“As a GP the medication review provides two very important elements, quality and safety. Patients in care homes are put on long lists of medication and many of them are not necessary, some medication may also be doing harm than good to the patient. Quite often we see a number of patients having falls because they’re on medication that is causing them to fall, the clinical care home pharmacist removes medication that is not necessary, change dosage, or formulation which will benefit the patient.

“As well as producing our animation featuring Doris, we have also developed a short video with health and care professionals. The video shows how healthcare professionals are carrying out medication reviews and how clinical care home pharmacists work closely with GPs, practice nurses, community practitioners, and care homes.”

The clinical care home pharmacists work closely with GPs and care home staff but where appropriate, and guided by care home staff, they speak to family members and carers of patients. This helps ensure that they are aware of any changes and highlight any concerns in proposed changes to a care home resident’s medication.

The project was a recent finalist in the ‘value and improvement in medicines management’ category at the Health Service Journal’s (HSJ) Value in Healthcare Awards 2014.

Animation: How medication reviews help patients like Doris

Meet Doris who will tell you how our clinical care home pharmacists have made a difference to her health by reviewing her medicines and helping her understand why she has taken them.

ENDS

Notes to editor

If you would like to interview the clinical care home pharmacists please contact the communications and engagement team at NHS Leeds West CCG on 0113 84 35528 or email: commsleedswestccg@nhs.net

Case studies

Prevention of hospital admission / quality of care (follow up)

An 82 year old patient who had a fast heart beat diagnosed in hospital was treated with a medicine to control their heartbeat (digoxin) and then went to live in a new care home. The clinical care home pharmacist carried out a medicine review and advised a blood test was done to check how well the digoxin was working as the dose was high for a patient who had other medical conditions. The blood test was taken and the digoxin level was high, this required the dose to be reduced by the clinical care home pharmacist.

If the level hadn’t been checked and the dose changed it would be highly likely that the patient could have been readmitted to hospital.

Post discharge

A review carried out by a clinical care home pharmacist at a residential home identified that a patient who had recently been discharged from hospital was still receiving a drug that had been stopped during the hospital admission. The medicine was a tablet to reduce fluid in the body (sometimes called a diuretic or water tablet). This tablet had been stopped by the hospital as it had made the patient lose too much fluid and she became dehydrated which had affected her kidneys. When the lady returned to the care home the carers had not crossed off the drug on the medication administration record (MAR) chart after her return from hospital ten days ago so this meant she was still being given the tablet. As this had been identified by the clinical care home pharmacist the medicine was then stopped. If the patient had continued to be given the incorrect medicine she might have been admitted to hospital again with dehydration and kidney problems.

Patient preference of medicines optimisation

A medication review by a clinical care home pharmacist highlighted that a patient was not taking their morning medicines because they liked to get out of bed late after the medicines round had been done. Some of these were large tablets which the patient found hard to swallow. The patient was prescribed ten medicines which added up to 25 different tablets and capsules throughout the day and they felt this was too many. The pharmacist along with the GP reduced the list of medicines, choosing medicines to give the patient the most benefit. The pharmacist also looked at the times the medicines were given and the type and size of tablets, capsules and liquids the patient needed and changed them safely to ones that better suited the daily schedule of the patient. The patient now takes eight medicines regularly with no problems including cardiovascular, diabetes and mental health medication.

Monitoring for safety and effectiveness of medicines

One patient that was reviewed was experiencing an excessive amount of drooling which was upsetting them. The clinical care home pharmacist looked to see if any of the medicines the patient was on could be causing this and one was identified. The pharmacist and the GP discussed this and reduced the dose of that medicine and the drooling reduced which was then less distressing for the patient.

Referral to other services

A review of a residential home patient who was having bowel and bladder problems showed that she could be having problems with the side effects of some of her medicines.  The patient was referred to a special nurse who reviewed her symptoms. The nurse was able to scan the patients’ bladder, diagnose the problem and get some additional treatments and aids to help make it easier for the resident to go to the toilet.

Key statistics

In the first five months of the service:

  • 490 patients reviewed.  61% of these required a follow up review as we had made changes to medicines or we had made a referral to a specialist service
  • £100k gross saving with £20k gross additional spent on new or changes to medicines to help the patient
  • £80k net overall saving from reviews
  • 25% of patients were identified as needing referral to another service for specialist assessment and care

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Issued by the communications team at NHS Leeds West CCG. You can contact the team on 0113 84 35528 or 0113 84 35470. Alternatively please email us: commsleedswestccg@nhs.net