Improving medicines optimisation for care home residents in Wigan Borough CCG

摘要

Introduction: Evidence suggests that, as a population, care home residents would potentially gain the most benefit from medication reviews. The Royal Pharmaceutical Society advocates that medication reviews should be pharmacist-led. Wigan Borough Olinical Commissioning Group (OOG) developed an approach to medicines optimisation for care home patients, which is evaluated here. Method: The care home team (average 1.26 whole-time equivalent [WTE] pharmacists and 1.80 WTE pharmacy technicians) worked with the borough's residential and nursing homes to improve medicines optimisation, in line with National Institute for Health and Care Excellence (NICE) guidance. The team provided structured medication reviews to form an agreement with the resident (or their carer) and their GP about treatment, aiming to optimise the impact of medicines, minimise the number of medication-related problems and reduce waste, while supporting care home staff to review and improve medication processes within the home. Results: Medication reviews were completed for 749 care home residents between August 2014 and March 2017. Of the recommendations made to prescribers, 85% were accepted, resulting in a reduction in inappropriate polypharmacy. Additional support was provided to 29 care homes - 41% of which achieved an improvement in Care Quality Commission (CQO) ratings. Discussion & conclusion: The care home team reviewed prescribing for care home residents that resulted in improvements in a number of key quality prescribing indicators and patient safety. Developing the role of the care home pharmacy technician has been particularly successful, and resulted in improved CQC ratings. Although CCGs are not responsible for monitoring or regulating care homes, the approach used by Wigan Borough demonstrated it is possible for COG staff to work collaboratively with care home and social oare teams to improve outcomes for residents.