A novel multi-disciplinary holistic medicines review for care home residents. (2025)

NHS Lanarkshire- Care Home Team

Project summary

Harm from medicines is a significant risk factor for hospital admissions. Up to 11% of unplanned admissions can be attributed to medicines related issues, and it is estimated that up to half of those admissions in the over 65 age group could have been prevented with appropriate polypharmacy reviews. To meet this challenge, within NHS Lanarkshire newly admitted care home residents have been reviewed by a multi-disciplinary team (MDT) since January 2022, and on review of this service, care homes with the highest number of emergency calls, hospital admissions and medicines waste were identified. The NHS Lanarkshire Care Homes Team led on the introduction of a novel multi-disciplinary holistic medicines review for all residents of one care home identified, as a four-month pilot to reduce medicines harm and waste. The aim was to develop a multi-disciplinary approach to a holistic medicines review with clearly defined responsibilities and referral pathways in the care home population, as well as reducing the risk of adverse events and harm from medicines, reducing risk of falls and reducing medicines waste.

An MDT was formed, including a consultant geriatrician, a pharmacist, a nurse and care home staff. A protocol was developed to include details of each MDT member’s role in the holistic medicines review. The pharmacist led a review on residents’ medicines, compliance and anticholinergic burden. Where appropriate, a mini cognitive exam was performed and frailty assessed using the Rockwood Clinical Frailty Scale. The nurse completed general physical checks including a review of continence, mood, nutrition and mobility. The consultant reviewed results from radiography, ECG, echocardiogram alongside lab results and any upcoming outpatient appointments to support the residents’ ongoing care. CPR status and power of attorney details were assessed and a ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) completed in collaboration with the resident and where appropriate, family members. An MDT meeting was then convened and changes to care discussed by the pharmacist with the resident and where appropriate, their family. Updates were communicated with the relevant GP practice to support continuity of care.

Over four months; 69 residents were reviewed. Ninety medicines associated with an increased falls risk were stopped, with a further 156 medicines stopped due to factors including non-compliance, unwillingness to use, no longer indicated and lack of patient benefit. Anticholinergic burden was reduced by 51 in a total of 32 residents and a reduction made of 28 medication rounds per day. A 12 month saving projection of £59,902 for medicines and catheters has been calculated for the identified care home.