Merton borough, South West London (SWL) CCG, provides an integrated pharmacy and dietetic support service to 40 care homes, of which there are a mix of nursing, residential and learning disability (LD) care homes. Work with care homes started in 2015. The medicines optimisation (MO) service is provided by a team of two pharmacists, a pharmacy technician and a dietitian. LD homes are supported by a specialist LD pharmacist via a contract from the local Mental Health trust. Historically, prescribing and medicines use in care homes has not been optimal as borne out in the CHUMS report (Care Home Use of Medicines Study, 2009). A significant proportion of medicines waste has been attributed to care homes (Pharmaceutical waste reduction in the NHS, NHS E 2015).
The approach taken to deliver MO involves not only reviewing individual residents' medications but encompasses a collaborative way of working with the wider healthcare system. To achieve this the main MO functions were to undertake medicines management audits, structured medication reviews, improve stakeholder engagement, provide dietetic support and communicate with care homes on a regular and consistent basis.
In order to establish medicines management processes in care homes a Medicines Management (MM) audit was designed (attachment Ai). The criteria within the audit were based on CQC requirements (Regulation 12) and NICE guidelines (2014) 'Managing Medicines in Care Homes'. The audit, undertaken by the pharmacy technician, was electronically completed at the point of the visit. The evidence gathered was assessed against the audit criteria. An example of the feedback is shown in attachment Aii.
Medication reviews are integral to our work and identify polypharmacy leading to clinical interventions with improved patient outcomes as well as reducing medicines waste. All interventions that have been reviewed by clinicians are recorded onto an interventions database. These are analysed for financial and quality benefits and reported at SWL STP level; reports may also be disseminated at various committees and groups, as appropriate. The annualised potential savings for 2019/20 amounted to approximately £60,000 with over 900 clinical interventions. The findings are also used to help the pharmacy care homes team identify support.
Oral Nutritional Supplements (ONS) are one of the highest cost prescription items in Merton. In the UK, it is estimated 40% of care homes patients are malnourished and therefore specialist dietitian input supporting the appropriate identification and treatment of malnutrition is essential. This project identified potential for significant cost savings achievable through reviewing care home patients on ONS to ensure appropriate use of ONS and effective management of malnutrition.
