Care home residents are often some of the frailest patients in our society, carrying significant polypharmacy. Adequate medicines management is pivotal in ensuring safe medicines handling and administration of medication in care homes. Feedback from healthcare colleagues locally and nationally, as well as safeguarding incidents and literature searches confirm that medicines management can be vastly improved. Poor medicines management practice can increase the risk of patient harm, but also generate significant waste and therefore significant cost.
Across Swansea Bay University Health Board (SBUHB) there are 3,196 available Care Home beds, with limited medicines management support. This is comparable to 1,310 beds across our four main hospital sites, which benefit from a minimum of 5 day medicines management support from pharmacists, pharmacy technicians and assistant technical officers (ATOs). Current services mainly focus on clinical intervention by pharmacists and doctors, such as the GP Care Home National Enhanced Service. Although this is important, without safe medicines management processes, specialist clinical involvement can be limited, if, for example, a medication is not available at the point of administration.
The SBUHB Medicines Management Team have employed a team consisting of pharmacists, pharmacy technicians and ATOs to mimic the hospital model to help optimise and promote effective medicines management practices with the aim of improving patient safety and reducing avoidable care home waste. Through completion of audits, waste assessment and observing medicines management practices, the team are able to discuss sustainable solutions for care homes to implement change and improve practice. Re-audit is then completed to assess development and identify cost savings through re-assessing avoidable waste. Additionally, a lack of education has been identified around medicines management and subsequently online education can be offered through the Prescqipp platform.
Through utilisation of ATOs and their skills to assess waste and complete audits, this has allowed the pharmacy technician workforce to undertake MAR chart reviews and then evaluate and amend quantities of medications where waste has been identified. This will also help ensure that over-ordering is limited by tailoring quantities of medications to specific residents needs and maintaining patient centred approach to medication reviews.
The team have utilised links with local teams and regulators, such as the long term care team, local authority safeguarding team and Care Inspectorate Wales to help identify those care homes most in need and maintain a prudent approach to working.
