May 3, 2016, by Editor

Case study on care home residents – why are pharmacists needed in care homes and how can better healthcare be delivered to members within this vulnerable group?

Robert OakleyThis blog has been written by Robert Oakley, one of our third year undergraduate students. It is the third of four posts about his experience in attending a King’s Fund conference in February 2016 on “Commissioning person-centred care for vulnerable groups: what role does pharmacy play?”.

The World Health Organisation (WHO) estimates that the aging population is due to rise between 20-40% in the western world in just the next 15 years. This presents some enormous challenges for health systems worldwide.
A large proportion of elderly people require residential care in a care home setting. However, due to the complex nature of diseases in the elderly and little medicines knowledge in care home settings many problems are encountered. For example, some care homes can experience a huge amount of medicines waste, inappropriate drug use, medicine supply issues and can have vulnerable, unsupported residents receiving sub-optimal pharmaceutical care. With the average UK resident taking over 7 different medicines a day which contribute to all of these factors, there is an enormous potential for pharmacy to make a difference in this sector.

In the latest report from the Royal Pharmaceutical Society (RPS) “The Right Medicine: Improving Care in Care Homes”  it is estimated that pharmacist interventions in care homes could save the NHS £135m a year through reduced hospital admissions, optimising medicines and reducing medicines waste. This is a significant sum which has gained the attention of NHS England presenting a very real opportunity for pockets of funding to be made available through Clinical Commissioning Groups (CCGs) for pharmacists to work in care homes.

Having a pharmacist assigned to each care home would enable care homes to keep on top of their residents’ medications which can be a very difficult task when different GPs visit the care home on a regular basis. This would significantly assist the already overstretched care home workforce as nurses, residents and family members could all benefit from medicines reviews conducted by pharmacists. It also presents an opportunity for the care home multidisciplinary team (MDT), residents and families to discuss treatment and be proactively involved in the decision making process.

As MPharm students learn in the central nervous system (CNS) module, Alzheimer patients in care homes could benefit enormously from pharmacist led interventions with concern around inappropriate use of antipsychotics, undiagnosed urinary tract infections (UTIs) and difficulty identifying pain in these patients. There are also many issues surrounding medicines compliance which pharmacists can assist with given memory is impaired. This will enable pharmacists to shape a more anticipatory form of care instead of a more costly reactive model.

Pharmacists in care homes

Pharmacists in care homes

The CHUMS study has highlighted many of the significant issues facing UK care homes, some of which are rather shocking. In light of the NHS 5 year forward plans for a more seamless delivery of healthcare that aims to keep the care of a patient as much as possible to the confines of their own home , specialist sites called vanguards have been created to trial future delivery of seamless healthcare. One notable Vanguard applicable to care homes is the SHINE project . The project was instigated by Northumbria Healthcare NHS Foundation Trust and showed that by having pharmacist independent prescribers working together with GPs, hospital geriatricians, care home staff, residents and their family to manage medication produced some outstanding results. Most of which have been extrapolated to the RPS “The Right Medicine” latest care home report.

With challenges around safeguarding and efficient medical expertise needed in palliative care, electronic integration of patient records and Medical Administration Record Sheet (MARS), issues surrounding care home medicines supply and the test of commissioning pharmacy led services; the prospect the role in care homes offer some dynamic and rewarding career pathways. The move will also encourage community pharmacists to be adopted as included members of the wider NHS multidisciplinary team.

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