Leicester City CCG piloted a project to support care homes with all aspects of medicines optimisation. The successful benefits included improving patient safety and reducing harm from medication which led to the commissioning of a team from University Hospitals of Leicester NHS Trust (UHL) in 2019 working together to improve outcomes and reduce inequalities for residents living in care homes.
The care home pharmacy team undertook specific enhanced clinical training and development provided nationally through the Centre for Post Graduate Pharmacy Education (CPPE) who developed a bespoke pathway for care home pharmacy professionals (pharmacists and pharmacy technicians) and aimed to capitalise on the innovation and development of care home medicines optimisation and management services across the country. The MOCH program was fully aligned to the Framework for Enhanced Health in Care Homes and demonstrated that the integration of Medicines Optimisation and Management within the framework has:
• Improved the quality of care through better medicines use.
• Reduced the risk of harm from medicines through medicines optimisation, safer medicines systems and staff training
• Released resources through medicines optimisation
The MOCH team works closely with GPs, care homes, care home subgroup committee, practice and PCN pharmacists, the LCCCG Medicines Optimisation team, and UHL to improve outcomes for care home residents. The team carries out patient centred Structured Medication Reviews (SMRs) and at care homes (working with GP practices) and at hospital in the frailty wards.
The joint care home pharmacy team felt passionately about sharing the positive lessons learnt from MOCH and utilised technology to incorporate aspects of MOCH to the structured medication review (smr) template so there was a standard approach amongst healthcare professionals conducting smrs using GP systems (emis and SystmONE) across Leicester, Leicestershire and Rutland. The key question being what is important to the patient? The joint care home pharmacy team have provided training and support to the new PCN pharmacists to conduct consistent high quality SMRs across LLR. We have also supported care homes during the COVID-19 pandemic though a check-in service, remote SMRs, producing policies for re-use of medicines in care homes and on the use of vitamin D in care home residents.
The inclusion of pharmacy teams in care homes (CCG and MOCH) has shown to
• improve quality patient centred care including shared decision making about which medicines care home residents take change or stop
• optimise the benefits of medicines and reduce the risk of harm from medicines stopping inappropriate or unsafe medicines, adjusting doses and ensuring medicines add value to patient's health and well-being
• to release healthcare resources
• be clearly aligned to the Framework for Enhanced Health in Care Homes and the ICS plans for Medicines Optimisation and Care Homes
• enhance and develop MDT working between Doctors Nurses PCN GP practice and community pharmacists, pharmacy technicians, other health and social care colleagues, care homes staff, patients and their families
• create better safer medicines management systems for care homes to reduce waste inefficiency and medicines related harm.
• Training and supporting care home staff to enhance safer administration of medicines
• Provide expert pharmaceutical input for CQC inspections and contract breaches for NHS and LA commissioned care home services
