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Reducing hospital admissions of frail elderly patients

The proactive care service in Coastal West Sussex (CWS), which was shortlisted for the HSJ Awards in 2015, provides medicines optimisation for frail elderly patients, reduces the risk of hospital admissions and made estimated savings of more than £600,000 in one year.

It is run by a team of senior clinical pharmacists who visit elderly patients with complex comorbidities in their place of residence to do medication reviews.

The clinical pharmacists are supported by a principal clinical pharmacist and all are part of the medicines management team at Sussex Community Trust. This structure provides support, leadership and coordination across the service.

The pharmacists are embedded in 13 proactive care teams of co-located health and social care professionals working closely with GPs. This facilitates liaison with other professionals to meet patients’ broader health and social care needs, for example, requesting review of a care package to prompt medicines administration.

The clinical pharmacy service was rolled out across the West Sussex region from April 2014. During the first year, the pharmacists made 1,178 medication reviews, of which 1,125 (96%) resulted in a reduced risk of harm from medications.

The overall impact of each review on the risk of harm from medicines is assessed. In this first year, 236 medication reviews had an impact score of 3 or 4 — considered to have contributed to reduced risk of hospital admission. This equates to a potential saving of £590,000. In addition, £49,560 was saved by pharmacist recommendations that led to deprescribing.

Additionally, the pharmacists contributed to individualised contingency plans that highlight predictable risks for hospital admission, advice for prevention, deterioration and response. Information added by the pharmacists may include risk factors for acute kidney injury, how to avoid dehydration, which medicines to withhold if acutely unwell, and when to seek medical advice.

Contingency plans are shared electronically with all professionals involved in patient care, including secondary care and acute services, and have resulted in a 30% reduction in conveyance to hospital in the event of an ambulance being called out.

The clinical pharmacy service is now considered a key component of the proactive care service and is commended by patients, GPs and other colleagues.

Future service developments might include incorporating pharmacy technicians into the team, developing the pharmacist role to include non-medical prescribing and further developing links with secondary care and community pharmacy.

Readers who are interested in finding out more about this service can contact me at karen.varisco@nhs.net.

Karen Varisco

Principal Clinical Pharmacist

Sussex Community NHS Trust

Citation: Clinical Pharmacist DOI: 10.1211/CP.2016.20200242

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