lucy alexakis & kate clarke medication review pharmacists shaping healthcare for you … and...

Care Home Medication Reviews

Lucy Alexakis & Kate ClarkeMedication Review Pharmacists

Shaping healthcare for you … and your family

1.6 WTE pharmacists employed April 2014 on a 12 month contract to:

- to review medication for patients in care homes- offer training around medication to the care homes- produce guidelines on medication to support GP’s and care

homes

NICE guidance SC1 “Managing Medicines in Care Homes” March 2014

NICE quality standard QS85 “Managing Medication in Care Homes” March 2015

Introduction


1060 patients have received a medication review in 46 care homes

1236 interventions 67 of these likely to have prevented a hospital admission based

on significance

General Examples - Stopping patients on incorrect drugs- Stopping drugs with no indications e.g. PPI’s- Updating allergy status- Dose reduction / stopping drugs due to eGFR e.g. ramipril,

memantine- Advice on formulation

Interventions(Up to end April 2015)


General Examples- Recommending calcium and vitamin D where appropriate

for fracture prevention - Bisphosphonate holidays- Drug monitoring advice e.g. Lithium - Dose optimising e.g. pregabalin- Interaction advice- Changing medication to increase compliance - Reminders and encouraging nursing homes to use

ONPOS for dressings and barrier preparations- Clarifying ASD directions - Waste prevention

Interventions Continued


Specific Examples A patient was identified as being prescribed twice the licensed rivastigmine

dose. This prescribing had been going on for a while since a hospital discharge. The dose was reduced immediately. This highlighted the issue of accurate medicines reconciliation after hospital discharge

A patient was identified as being prescribed sulphadiazine suspension, having looked through the notes a discharge summary from the hospital made it clear that the patient should have been receiving sulphasalazine suspension for rheumatoid arthritis. GP was contacted and the sulphadiazine was stopped immediately. As a special it had also be costing over £400 per month for 9 months.

Interventions Continued


Memantine eGFR 30–49 mL/minute/1.73 m2 reduce dose to

10mg, if well tolerated after at least 7 days dose can be increased in steps to 20 mg daily

eGFR 5–29 mL/minute/1.73 m2 reduce dose to 10mg

eGFR less than 5 mL/minute/1.73 m2- avoid

Sulphasalazine and sulphadiazide Hydroxyzine and Hydralazine

Sharing Points


1060 patients have received medication review £142,191 per annum predicted gross drug saving £54,527 per annum predicted net drug saving Approximately £134 per patient per annum saving

67 hospital admissions likely to have been prevented, assuming 50% of these actually prevented an admission (conservative estimate) estimated predicted cost savings for unplanned admissions is £80k

Financial Update


A locally adapted Medication Review tool Identifies medication which may need stopping in

the elderly as risks outweigh the benefits e.g. first generation antihistamines (fall prevention)

Identifies suitable medications for starting in the elderly or preventative medications e.g. calcium and vitamin D supplements in patients with osteoporosis

STOPP/START Toolkit

STOPP/START Toolkit


Oral Nutritional Supplement Project

Anna Clayton, Community Nutritional Management Specialist (Dietitian)

So far: Effective Management of Malnutrition Pathway written Resources available on share point, both guidance to prescribers

and information to print and give to patients 12 care homes audited and 104 residents reviewed. Potential

annualised savings of £75,450 identified so far. System issues and wide changes in standards identified. Training

started in care homes to encourage Food First and support good nutritional care

Change in supplement prescribing pattern beginning to emerge, decrease in prescribing spend, February and March lowest prescribing spend for 6 months.


Care Home Training Packs Care Home educational sessions Bulk prescribing & Homely remedies guidance for

care homes and GP’s Hydration Guidelines Medication expiry date guidance Working with dentists on shared care

Available at http://pad.res360.net/

Other guidance and work


http://pad.res360.net/

http://pad.res360.net/

lucy alexakis & kate clarke medication review pharmacists shaping healthcare for you … and...

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