Lucy Alexakis & Kate Clarke Medication Review Pharmacists Shaping healthcare for you … and your family

 1.6 WTE pharmacists employed April 2014 on a 12 month contract to: - to review medication for patients in care homes - offer training around medication to the care homes - produce guidelines on medication to support GP’s and care homes  NICE guidance SC1 “Managing Medicines in Care Homes” March 2014  NICE quality standard QS85 “Managing Medication in Care Homes” March 2015 Shaping healthcare for you … and your family

 1060 patients have received a medication review in 46 care homes  1236 interventions  67 of these likely to have prevented a hospital admission based on significance General Examples - Stopping patients on incorrect drugs - Stopping drugs with no indications e.g. PPI’s - Updating allergy status - Dose reduction / stopping drugs due to eGFR e.g. ramipril, memantine - Advice on formulation Shaping healthcare for you … and your family

General Examples - Recommending calcium and vitamin D where appropriate for fracture prevention - Bisphosphonate holidays - Drug monitoring advice e.g. Lithium - Dose optimising e.g. pregabalin - Interaction advice - Changing medication to increase compliance - Reminders and encouraging nursing homes to use ONPOS for dressings and barrier preparations - Clarifying ASD directions - Waste prevention Shaping healthcare for you … and your family

Specific Examples  A patient was identified as being prescribed twice the licensed rivastigmine dose. This prescribing had been going on for a while since a hospital discharge. The dose was reduced immediately. This highlighted the issue of accurate medicines reconciliation after hospital discharge  A patient was identified as being prescribed sulphadiazine suspension, having looked through the notes a discharge summary from the hospital made it clear that the patient should have been receiving sulphasalazine suspension for rheumatoid arthritis. GP was contacted and the sulphadiazine was stopped immediately. As a special it had also be costing over £400 per month for 9 months. Shaping healthcare for you … and your family

 Memantine  eGFR 30–49 mL/minute/1.73 m 2 reduce dose to 10mg, if well tolerated after at least 7 days dose can be increased in steps to 20 mg daily  eGFR 5–29 mL/minute/1.73 m 2 reduce dose to 10mg  eGFR less than 5 mL/minute/1.73 m 2- avoid  Sulphasalazine and sulphadiazide  Hydroxyzine and Hydralazine Shaping healthcare for you … and your family

 1060 patients have received medication review  £142,191 per annum predicted gross drug saving  £54,527 per annum predicted net drug saving  Approximately £134 per patient per annum saving  67 hospital admissions likely to have been prevented, assuming 50% of these actually prevented an admission (conservative estimate) estimated predicted cost savings for unplanned admissions is £80k Shaping healthcare for you … and your family

 A locally adapted Medication Review tool  Identifies medication which may need stopping in the elderly as risks outweigh the benefits e.g. first generation antihistamines (fall prevention)  Identifies suitable medications for starting in the elderly or preventative medications e.g. calcium and vitamin D supplements in patients with osteoporosis Shaping healthcare for you … and your family

Anna Clayton, Community Nutritional Management Specialist (Dietitian) So far:  Effective Management of Malnutrition Pathway written  Resources available on share point, both guidance to prescribers and information to print and give to patients  12 care homes audited and 104 residents reviewed. Potential annualised savings of £75,450 identified so far.  System issues and wide changes in standards identified. Training started in care homes to encourage Food First and support good nutritional care  Change in supplement prescribing pattern beginning to emerge, decrease in prescribing spend, February and March lowest prescribing spend for 6 months. Shaping healthcare for you … and your family

 Care Home Training Packs  Care Home educational sessions  Bulk prescribing & Homely remedies guidance for care homes and GP’s  Hydration Guidelines  Medication expiry date guidance  Working with dentists on shared care Available at Shaping healthcare for you … and your family