Better utilisation of pharmacists’ skills in care homes will benefit all parties

The English Pharmacy Board is calling for pharmacists to have overall responsibility for medicines and their use in care homes. This will result in better use of medicines and will benefit care homes, residents and their carers, and the NHS. The English Pharmacy Board held a summit on care homes on 10 December 2015 and will launch its care home campaign in a joint event with the King’s Fund on 24 February 2016.

There are around 5,000 nursing homes and 12,500 residential homes in the UK^[1]
. The resident care home population is ageing; in 2011, people aged 85 years and over represented 59.2% of the care home population compared with 56.5% in 2001^[2]
. Older people in care homes are often taking several medicines to treat multiple morbidities; individual residents in care homes are prescribed an average of eight medicines^[3]
.

More than 90% of elderly care home residents in a 2011 study^[4]
had been exposed to at least one potential medicine administration error. A 2009 report showed that two-thirds of care home residents had experienced one or more medication error^[3]
 and that these errors may have occurred as a result of a failure in prescribing, dispensing, administering or monitoring medicines. To improve the safe and effective use of medicines by people of all ages who live in care homes, clear systems and processes are needed across the medicines management pathway^[5]
. Medicines safety could be further improved if patients’ medical records were shared between GPs and community pharmacists and were also accessible in the care home^[3]
.

NHS England’s ‘Five year forward view’^[6]
calls for the development of shared models of support for care homes including medicine reviews. There is evidence that multidisciplinary interventions are efficient in providing effective medicine reviews^[7]
. Pharmacist medicine reviews also lead to a reduction in falls in care homes^[8]
.

Reducing the use of psychotropic medicines for people with dementia or learning disabilities living in care homes and ensuring patient safety when psychotropics are needed should be a priority^[9]
. The care home provider, prescriber and pharmacist should agree with the resident the best time for them to take their medicines. Busy times should be avoided as more errors occur at these times^[5]
.

International research shows that some care home residents are prescribed medicines inappropriately, which can lead to harmful side effects and a loss of therapeutic benefit. The Care Home Use of Medicines Study (CHUMS)^[3]
examined a random sample of 256 patients in 55 care homes and found that 70% of care home residents experienced at least one error associated with their medicines. The study suggests that, in order to prevent errors, pharmacists should regularly review resident medicines and rationalise regimes to help care home staff work in a safer way. A four-month trial in a care home in London where a pharmacist was given full responsibility for medicines management resulted in a 91% reduction in medicine-related errors^[4]
.

Pharmacy services for care homes are still mainly limited to supply of medicines, and care homes are often served by multiple GP surgeries and pharmacies. ‘Pharmacy advice visits’ have been commissioned in some areas, which provide staff with training and advice on proper use of medicines – this should form the minimum service provision. Pharmacists should lead a programme of regular medicines reviews and training working in an integrated team with other healthcare practitioners, ensuring medicines safety. Pharmacists should need no additional training to carry out this role but should ensure that they have the appropriate level of safeguarding training.

The English Pharmacy Board is calling for better use of pharmacists’ skills as part of a multidisciplinary team in care homes to benefit care home residents, care homes providers and the NHS. As a basis for change, one community pharmacy and one GP practice should be aligned to a care home to enable the provision of a coordinated and consistently high standard of care across all service users. This is in line with the views of the Royal College of General Practitioners and the British Geriatric Society.

• RPS members can get a 20% discount for the King’s Fund launch event on the 24 February 2016 by using the discount code RPS_20 when booking online.