Highly commended - Embedding Medicines optimisation and Holistic review of Learning Disability care home residents across South West London (2020)

South West London CCG

Project Summary

A pilot project was launched in January 2019 to provide medicines optimisation reviews for adults with learning disabilities living in care homes (LDMOCH) in South West London. This was to address unmet needs surrounding medicines optimisation, as identified by the national STopping Over Medication of People with learning disability, autism or both (STOMP) programme.

People with learning disabilities (LD) die 23-27 years earlier than their non-disabled peers(1). In 2015, Public Health England estimated that 30,000-35,000 adults with a learning disability receive psychotropic medicines without an appropriate indication(2).

Three care home pharmacists specialising in learning disabilities reviewed the medicines and any associated care plans.

Over 9 months, 405 patients were reviewed and monitored, resulting in:

• £119,165 cost avoidance
• £52,660 annualised medicines cost savings
• 212 (21%) interventions were associated with STOMP (psychotropic medicines reduced/started/stopped/restarted/changed)
• 70 (7%) interventions were associated with minimising the use of medicines with increased anticholinergic burden.
• 20 (2.9%) interventions resulted in withdrawal and reduction of sedative hypnotic medicines
• 278 medicines were stopped
• 47 medication incidents were identified by the pharmacists. All were investigated and forwarded for appropriate follow up.

This project has led to a quality improvement initiative to improve the response across the integrated care system to improve the response to behaviour that challenges in patients with a learning disability and/ or autism.

(1) Heslop P et al. Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD). The Lancet. 2014;383(9920):889-895.
(2) Public Health England. Prescribing of psychotropic drugs to people with learning disabilities and/or autism by general practitioners in England. 2015.