Pharmaceutical Care Awards
Involving care home patients in decisions about their medicines
How a framework was developed for multidisciplinary reviews of medication in nursing homes.
Source: Nadia Attura
Care home residents and their families should be involved in decisions about their medicines, according to a team of pharmacists from Northumbria Healthcare NHS Foundation Trust (NHNFT) who created a care home medicines optimisation service to achieve just that. As one of six finalists at the Pharmaceutical Care Awards 2014, the team scooped the audience choice award for the project most able to be replicated elsewhere.
“We know that when you involve patients in their own healthcare you improve safety,” said Steven Barrett, senior clinical pharmacist at NHNFT, in the awards Q&A session. “This was the main driver of the project.”
The service involved a two-phase medication review: a clinical pharmacist would first undertake a detailed review of a resident’s medicines using care home and GP data; a multidisciplinary team (MDT) would later meet to agree any recommended interventions.
Three different models for undertaking MDT meetings were designed to complement the varying ways that GPs work with care homes. Residents, their family members or both were invited to the MDT meeting or were visited or called by the pharmacist after the meeting.
“GP practices work in different ways in terms of their input into care homes. We decided that if this was going to work, it was going to have to be able to apply to everyone,” explained Barrett, describing why the team decided to design a multi-model service.
The service that we provided ended up being an extraordinarily flexible and variable system, but at its core had some key elements and key interventions
Quantitative data collected included number and type of interventions made to optimise medicines and safety, and levels of resident involvement. Qualitative data collected included gathering residents’ views on being involved in decisions about their care.
The researchers reported that for the 422 residents reviewed during the project, 1,346 interventions were made — most of which involved the discontinuation of medicines. The main reasons for stopping a medicine were because there was no current indication for it or the resident requested to stop it. In 46 cases, a medicine was stopped because of risk of harm to the resident.
Some 16% of residents were fully involved in the decisions that were made about their medicines. A total of 39% of residents had a family member involved and the team sent letters the family members of 40% of residents informing them of the changes to medicines. According to the project team, residents and family members valued being involved in the reviews.
Secondary outcomes evaluated included time taken for care home staff to administer medicines before and after review. The researchers observed that care home staff spent, on average, 6.6 fewer hours each week administering medicines after the reviews.
The team used short PDSA (plan, do, study, act) cycles to develop the intervention. “A big part of the PDSA cycle is giving things a go,” NHNFT chief pharmacist David Campbell told the audience. “If you look at the principle around our project — trying to do the best for and give a voice to vulnerable patients — there were lots of different ways that we delivered these. The service that we provided ended up being an extraordinarily flexible and variable system, but at its core had some key elements and key interventions.
”PDSA is about giving new models a go and having the confidence to change the model if it doesn’t fit the circumstances. This is why we were able to make the interventions successful across 20 care homes and individual GP practices.”
Campbell and Barrett were joined on the team by Wasim Baqir, research and development pharmacist, Richard Copeland, head of clinical pharmacy and deputy chief pharmacist, and Nisha Desai, senior clinical pharmacist, all at NHNFT.
About the awards
The Pharmaceutical Care Awards 2014 were held on 19 June at the Royal Institution in London. The awards are run by The Pharmaceutical Journal and the Royal Pharmaceutical Society (RPS) and are supported by GlaxoSmithKline (GSK).
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065884
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