1. Pharmacy Integration Improving care in care homes
Wasim Baqir, Emily Wighton
February 2018

2. Medicines Use in Care homes
Excess medicines (unnecessary/ inappropriate)
Medication Errors
Lack of structured review
Medicines Waste
Rare patient involvement
Silo working

3. Polypharmacy: negative health outcome
Prybys 2002
Fulton 2005
Risk of a medicines related adverse event
Fulton 2005

4. Polypharmacy: Under-prescribing
Failure to prescribe medicine to treat disease or prevent disease
Polypharmacy increases the chance of under-prescribing
The Treatment-Risk Paradox (Ko 2004)
OR=4.8
95% CI )
Kuijpers (2007)

5. Medication Errors PREVALENCE AND ECONOMIC BURDEN OF MEDICATION ERRORS IN THE NHS IN ENGLAND Policy Research Unit in Economic Evaluation of Health and Care Interventions
41.7% of 237 million errors in care homes
Medicines Optimisation
Prescribing errors (3%)
Monitoring errors (6.9%)
Care Home Systems
Administration errors (92.8%)
Other
Dispensing errors (3.6%)

6. Optimising the use of medicines

7. Medicines Optimisation Support

8. The Vanguards System Leadership
Northumberland
PACS
System Leadership
Joined-up primary, community and secondary, social care
…across a place and population
Learning so far
The how is as important as the what.
Relationships are the foundation.
Up to 21% reductions reported emergency hospital admissions
£ per resident drug savings reported
7% reduction in oral nutritional support usage
1%-30% reduction in ambulance call outs
Slide courtesy of Liam Paul
NHS England, New Care Models team

9. Enhanced Health in Care Homes
Seven care elements
Enhanced primary care support
Medicine reviews
Multi-disciplinary team (MDT) support including coordinated health and social care
Reablement and rehabilitation
High quality end-of-life care and dementia care
Joined-up commissioning and collaboration between health and social care
Workforce development
Data, IT and technology

10. Good ‘evidence’ & practice, yet we still have a problem!

11. Pharmacy Integration: Care Homes Programme
Next Steps on the Five Year Forward View
Pharmacy Integration Fund will prioritise and focus on urgent care and supporting general practice
Deployment of clinical pharmacy professionals & pharmacy services into care homes
Development of ‘infrastructure’

12. Medicines Optimisation in Care Homes
Training pathway
HEE commissioned to find provider
Pharmacists and pharmacy technicians
Independent Prescribing
Pharmacists and technicians working across care settings to support care homes
Medicines optimisation
Care home systems and staff
Antimicrobial stewardship
Integrating into the ‘system’ (GP, Hospital, Community Pharmacy
Infrastructure
Networks, IPACS, Data & Metrics, Polypharmacy Support

13. Programme 2017-18: Phase 1 – ACS/STP/Vanguards
Aligning to EHCH
Testing metrics and systems
: Phase 2 – National Funding
STP/ICS
Training
Mixed models to allow local solutions
Reporting and Metrics
Support & Infrastructure development

14. @wasimbaqir
@emilywighton