Medicines Management in Care Homes

1. Medicines Management in Care Homes Bharat Patel Head of Medicines Management NHS Walsall June 2011

2. Current service provision • NHS Walsall employs 1 W.T.E Medicines Management Technician (MMT) to undertake audits & to support care homes. • E.g. providing sample policies such as Homely Remedies • Community Pharmacists are contracted via a local enhanced service agreement to undertake quarterly audits and to provide help and support to care homes.

3. Audits • A programme of audits for care homes began in April 2009 • 73 care homes in Walsall, both nursing & residential are included • One audit is undertaken each quarter and of these: • 25% are undertaken by the MMT • 75% are undertaken by Community Pharmacists

4. Medicines Policy Checklist Controlled drugs Nutritional supplements Waste Medicines Medicines Administration Antipsychotics in Dementia Drug Monitoring Asthma – the use of inhalers Audits Undertaken So Far

5. Results • Audits are collated and evaluated by the MMT and training and support offered as necessary. • Feedback is given to each care home and the community pharmacists who undertook the audit • Quarterly newsletters are also sent out to care homes giving advice and updating care home staff on any medicines management issues.

6. Care Homes Use of medicines Study (CHUMS) • This study found that: • Care home residents (mean age 85 years) were taking 8 medicines each • On any one day 7 out of 10 patients experienced at least one medication error

7. CHUMS found that • 14.7% of medicines requiring monitoring had an error. • 90.6% of monitoring errors resulted from a failure to request monitoring • Drugs most commonly associated with monitoring errors were: • Diuretics, Ace inhibitors, Amiodarone and Levothyroxine

8. Response to CHUMS • To audit • Medicines Administration • Drug Monitoring

9. Medicines Administration AuditResults

10. Medicines administration audit • The audit has showed that the required standard of 100% accuracy for the recording and administration of medicines on MAR charts was NOT achieved. Only 56% of care homes scored 100%. • Although the audit didn’t uncover any obvious administration errors the main problems seemed to be in recording and filling in the MAR charts correctly.

11. Drug Monitoring Aims • To determine if residents receive appropriate drug monitoring. • To ensure staff are aware of the need for regular monitoring and to promote information sharing between the home and GP

12. Results

13. Ensure a complete record is kept for each resident to say when they last had a blood test, what the results were and when they are due to have another one. Use the sample record sheet provided as part of the audit so that staff are aware when someone is prescribed a drug that will require regular monitoring. Actions

14. Medicines waste

15. Medicines waste

16. Money wasted on medicines each year in Walsall £1-3 million Potentially the cost of 3401 Cataract operations or 909 Percutaneous coronary interventions – stents or 588 Hip replacements or 340 Coronary Artery Grafts

17. Forms developed For: Notification of non-urgent changes to medication. E.g. to reduce quantity of meds required via Practice Pharmacists. Nutritional assessment using a validated assessment tool (MUST) Reducing Waste byCommunicating with GP practices

18. FOR THE ATTENTION OF THE PRACTICE PHARMACIST Notification of NON URGENT changes to resident’s medication (This form should be filled in if the resident’s GP or Consultant has made a change to their medication. It may also be used to ask for an alteration in the quantity of a ‘when required’ medication if necessary or to ask for instructions to be included on medicines previously labelled ‘as directed’. It should then be faxed to the GP practice for the attention of the Practice Pharmacist) Name of resident……………………………………………………………………………………… Date of Birth …………………………………………………………………………………………… Name of home………………………………………………………………………………………….. Address of home……………………………………………………………………………………….. ……………………………………………………………………………………………………………. Please alter the patient’s records for the following medication. (Enter name, dose and quantity of medication required each month) ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… This medication has been changed because: (e.g. The GP/ Consultant has changed the dose or the quantity needs to be reduced as the patient only takes the medication when required or the patient is unable to swallow the medication and needs an alternative etc.) ……………………………………………………………………………………… ………………………………………………………………………………………… …………………………………………………………………………………………. …………………………………………………………………………………………. Authorised by …………………………………………………… (Name of GP or Consultant) Signature of Nurse/ Carer in charge …………………………………………………………. Print Name ………………………………………………………Date ……………………… Signature of Pharmacist …………………………………………….. Date alteration made …………………………………………………. Confirmed with GP? Yes/ No

21. Any Questions? Contact Details- Bharat Patel Head of Medicines Management Email bharat.patel@walsall.nhs.co.uk Wendy Bagnall Medicines Management Technician Email wendy.bagnall@walsall.nhs.co.uk THANK YOU