Experts call for pharmacist in every British care home to boost safety

The safety of older people could be improved and NHS savings of £135m a year made by having a pharmacist in every care home across Britain, according to the Royal Pharmaceutical Society (RPS).

In its report ‘The Right Medicine - Improving Care in Care Homes’, the RPS believes pharmacist-led medicine reviews in care homes could save £190 per resident by preventing avoidable hospital admissions caused by drug-related adverse events. When this saving is applied to the number of older care home residents across the UK taking at least one medicine, the RPS stated £75m a year could be saved.

The report said pharmacist-led medicine reviews with residents and their families could save as much as £60m each year, as a result of a pharmacist stopping, reducing, starting or changing medication.

Errors in medicine administration

There are currently 405,000 care home residents in the UK aged over 65 years old with 97 per cent being prescribed at least one medicine. However, the report said almost three quarters are exposed to at least one medicine administration error.

Antipsychotics

The report stated that in 2009, it was estimated that 25 per cent of residents of care homes for the elderly were prescribed antipsychotics. One study showed antipsychotic dispensing increased from 8.2 per cent before a person enters a care home to 18.6 per cent after entering and dispensing of hypnotics increased from 14.8 per cent before entry to 26.3per cent after entering.

In response to the report’s findings, the RPS, Alzheimer’s Society, The Patients Association and Care England have called for a pharmacist, as part of the healthcare team in care homes, to take charge of the whole system of medicines and their use within a care home to improve patient care, reduce the waste of NHS medicines and prevent the harm that can be caused by inappropriate medicines being given to residents.

Laurie Thraves, senior policy officer at Alzheimer’s Society said: “With 70 per cent of people in care homes estimated to have dementia, having a pharmacist on hand to support people with the condition to manage and review their medication on a regular basis would be a welcome measure.

“Many people with dementia live with other long-term health conditions and there is a danger that, without effective management, they could end up on a number of drugs which could interact negatively with each other, exacerbating the symptoms of their dementia.

"Having a visiting pharmacist in care homes has the potential to both save money and improve quality of life.”

Residents take seven medicines a day on average

Sandra Gidley, chair of the RPS English board said: “Care home residents take an average of seven medicines a day with some taking double or treble this amount.

“Without a regular review of what’s still needed, this cocktail of drugs can cause poor health, a lower quality of life and costly unnecessary admissions to hospital."

Research undertaken in 2009, calculated medicines wastage in England cost £300m each year; of which £24m is unused medicines disposed of by care homes. Each potentially saved hospital admission saves £3,500, based on the average length of stay for an older person arriving at A&E.

Ms Gidley said: “At a time when GP workloads are overwhelming and the NHS needs every penny, pharmacists can provide the solution by stopping the use of unnecessary medicines, upgrading residents to newer types of medicines with fewer side-effects and reducing the amount of wasted medicines.

“Having a pharmacist responsible for the use of medicines in a care home, as part of the team of health professionals would also bring significant savings through regular reviews.

"The evidence is clear: now is the time for the NHS to act and improve the care of residents by ensuring a pharmacist has responsibility for the whole system of medicines and their use within a care home.”

Shiraz Khan, head of Careplus Customer Experience, expects to see demand for his firm’s technology-based service rise following calls to have a pharmacist on site permanently at care homes.

He said: “There’s no denying that having ongoing access to pharmacist support whether on-site or through innovative technology will benefit care homes. Our Well Pad device links pharmacists directly to carers but it could also be used by pharmacists in care homes. It gives the correct medicine to the correct resident, helping to reduce medicine wastage and makes it easier for carers or pharmacists to manage medication, eradicating human error.

“The cost involved with solely employing a permanent pharmacist would be far higher than implementing our Well Pad technology. We welcome the recent comments about pharmacists being heavily involved in care homes and would expect to see demand for our technology increase as a result.”

The report by the RPS, a professional body for pharmacists in Britain, is based on discussions with the families of care home residents, care home providers, local authorities, care professionals and expert pharmacists.

The report recommends

• Pharmacists have overall responsibility for medicines in care homes.

• One pharmacist and one GP should be responsible for medicines in each care home ensuring coordinated and consistently high standards of care.

• Where a care home specialises e.g. in dementia care, the pharmacist should ensure they are competent to support the relevant clinical speciality.

• Local commissioners (such as Clinical Commissioning Groups or NHS England) should commission pharmacists to provide medicine reviews in care homes.

• Pharmacists should lead a programme of regular medicine reviews and staff training, working in an integrated team with other healthcare practitioners ensuring medicines safety.

To read the report ‘The Right Medicine - Improving Care in Care Homes’ visit: http://www.rpharms.com/promoting-pharmacy-pdfs/care-homes-report.pdf