Winner - Beyond Cost Savings: Building a Skilled Care Home Medicines Service

Shropshire Community Health NHS Trust

Project summary

We developed a pharmacy-led care home medicines optimisation service to address low levels of medication review, high-risk prescribing and variation in medicines management across care homes. The aims were to reduce inappropriate prescribing, improve safety and build capability within care home teams, enabling care to be delivered more safely and closer to home.

During the six-month pilot, the team worked with 12 care homes and reviewed medicines for 320 residents. Through targeted structured medication reviews, medicines reconciliation, anticholinergic burden (ACB) scoring and clinical discussions with GPs and care home staff, we made more than 120 pharmacist-led interventions. These included deprescribing, dose reductions, medicine switches and formulation changes. We focused on medicines associated with falls, sedation, anticholinergic burden, hypoglycaemia and hospital admissions.

Partnership working was central to the project. We worked closely with care home staff, primary care network (PCN) pharmacy teams, GPs and community pharmacies to review complex cases, implement recommendations and evaluate impact. We also provided training and support for care home staff on medicines safety, diabetes management, insulin storage and administration, continuous glucose monitoring (CGM), the EMIS proxy ordering system, falls prevention and safe deprescribing. This developed staff skills and confidence and strengthened their role in medicines management.

Diabetes care was a major area of progress. We supported the introduction of CGM, improved insulin optimisation and developed the case for care home staff to administer insulin safely with appropriate training and supervision. This can reduce reliance on district nursing visits, release district nursing time for people with more complex needs and support care closer to home.

Patient outcomes were positive. We reduced anticholinergic burden in 60 residents, all of whom achieved an improved ACB score. We also addressed high-risk medicines, including opioids, benzodiazepines, antihypertensives, insulin and sulfonylureas, reducing the risks of falls, sedation, cognitive harm and hypoglycaemia.

Supporting care home staff to make full use of the EMIS proxy ordering system saved time by enabling medicine orders to be placed promptly, without lengthy telephone calls or extended periods on hold. This freed care home staff to spend more time supporting residents and showed how a simple digital change can improve patient care.

The pilot demonstrates that pharmacy-led support for care homes can improve patient safety, strengthen staff skills, enable digital working and support diabetes care. It also provides a clear case for sustainable funding.