Medicines Optimisation in Care Homes
Medicines Management Team, Aylesbury Vale and Chiltern CCGs
Background
Studies report a reduction in inappropriate polypharmacy, errors, and cost achieved by pharmacist
input in care homes.
In addition, a pharmacist can identify gaps and lead on targeted actions in key therapeutic areas to
support the provision of high quality care and safety for care home residents.
The Buckinghamshire CCGs Medicines Management Team in collaboration with the county’s Quality
in Care Homes Team is delivering a Medicines Optimisation in Care Homes project. The project
involves pharmacists reviewing and making recommendations on individual resident medication
regimes and carrying out wider system and medicines management process reviews in selected care
homes.
Evidence based quality aims and measures have been used for specific areas where pharmacists are
able to intervene to influence quality of care. Data related to these is being collected and used to
identify:
 Gaps in service provision
 Areas of risk
 Where good practice guidance and training could improve medicines use and
pharmaceutical care on a wider scale
The project includes scoping solutions and implementing local actions to address issues raised.
Quality aims and rationale
1. To ensure the management of pain is optimised
a. Local intelligence suggests room for improvement
b. The effective management of pain in dementia can play an important part in
treating agitation and could reduce unnecessary prescriptions for psychotropic
drugs1
2. To ensure prescribing of antipsychotic medication is appropriate
a. Inappropriate prescribing can increase cardiovascular morbidity and mortality in
patients with dementia2.
b. A local care home survey identified high levels of prescribing
3. To ensure all medication that has a high risk of causing falls is reviewed
a. Fracture of femur is identified locally as a significant cause of hospital admissions
from care homes
4. To ensure all medication that is a high risk of causing an admission is reviewed
a. Preventable drug related admission rates reported in literature vary from 1.4% to
15.4% (median 3.7%)3
5.
6.
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b. Four groups of drugs account for more than 50% of the drug groups associated with
preventable drug-related hospital admissions. Reasons for drug related admissions
include: prescribing problems, patient adherence problems and inadequate
monitoring4
To prevent urinary tract infections and support appropriate management
a. Locally this is identified as one of the top causes of hospital admissions
To review and stop the inappropriate prescribing of antimuscarinics for urinary
incontinence
a. Long term use of antimuscarinic medication can contribute to cognitive
impairment5
To ensure all medication prescribed for a patient is appropriate for their needs
a. About a half of nursing home residents are on at least one inappropriate drug6,7
To ensure medication is prescribed and administered as intended
a. A study in 55 care homes found 256 residents were taking a mean of eight
medicines. 69.5% of residents had one or more medication error8
To ensure unidentified cases of dementia are appropriately assessed and recorded
a. Locally dementia diagnosis rates are low compared to expected prevalence
Medicines Optimisation in Care Homes: References
Medicines Management Team, Aylesbury Vale and Chiltern CCGs
1. Husebo, BS et al. Efficacy of treating pain to reduce behavioural disturbances in
residents of nursing homes with dementia: cluster randomised clinical trial. BMJ
2011;343:d4065
2. The Department of Health. The use of anti-psychotic medication for people with
dementia: Time for action. Professor Sube Banerjee, November 2006
3. East & South East England Specialist Pharmacy Service. Medicine Related problems on
Admission to Hospital – The Evidence. Apr14 V1
4. Howard, RL et al. Which drugs cause preventable admissions to hospital? A systematic
review. BR J Clin Pharmacol. Feb 2007; 63(2):136-146
5. Fox, C et al. Anticholinergic Medication Use and cognitive Impairment in the Older
population. J Am Geriatr Soc. 2011;59(8):1477-1483
6. Beers, M et al. Explicit criteria for determining inappropriate medication use in nursing
home residents. Archives of Internal Medicine. 151. 1825-1832. 1991.
7. Lunn, J et al. A study of the appropriateness of prescribing in nursing homes.
International Journal of Pharmaceutical practice. 5. 6-10. 1997.
8. Barber ND et al. Care homes’ use of medicines study: prevalence, causes and potential
harm of medication errors in care homes for older people. Qual Saf Health Care, July
2009;18:341-346.