A clinico-ethical framework for

multidisciplinary review of medication in nursing

homes

Wasim BaqirOn behalf of the Shine Care

Edith

Unacceptable Patient Experience

Excess inappropriate

medicines

Lack of structured review

Lack of patient involvement

Our objective

Optimise medicines use incare home residents…

…ensuring that residents or their family are fully involved in any decisions around prescribing and

stopping medicines

Key Learning

• Not all patients have the capacity to make complex decisions – However, patients should have a say– Patient Involvement Framework

• MDT Model– One size does not fit all, but…– Pharmacist, Care Home Nurse, Patient are key– GPs, POAS service

Key Results

• 362 patients reviewed– 945 interventions – 54% (512) stop medicines in 219 patients (61%)– Start medicines, dose changes, dose forms,

monitoring, etc.• Drugs stopped because– Unnecessary– Safety– Unwanted

Key Results• 362 patients reviewed

– 945 interventions – 54% (512) stop medicines in 219 patients (61%)– Start medicines, dose changes, dose forms, monitoring, etc.

• Drugs stopped because– Unnecessary– Safety– Unwanted

• Financial Benefits– £55,000 saved on prescribing budget– Less nursing time to administer medicines– Reduced medicines waste

Involving Patients: our model

Patient

FamilyFamily by

letterAdvo-cacy

Involving Patients: our model

Patient

FamilyFamily by

letterAdvo-cacy

17%

40%

23%

4%

Family Perceptions

“I think we should be notified if something was going to be stopped. [pharmacist] discussed about

taking her off a Statin. But at the minute I think she is happy and has really good quality of life, I

don’t think she should be taken off things without consulting the family with a good reason for her

to be taken off them”

“There is no point people being on things

unnecessarily. You don’t need to be on them, why be

on them”

What next?

• Sustain– Business case to local CCGs– Local adoption by some practices– Adoption by neighbouring CCGs

• Spread– Local marketing– National awards– Publication– Health Foundation

Our Team• Wasim Baqir – Project Lead• Annie Laverty (Director of Patient Experience) • Prof Julian Hughes (POAS/Newcastle

University) – Clinical Lead• Nisha Desai/Steven Barrett – Clinical

Pharmacists• Joanne Mackintosh – Patient Experience• Peter Derrington – Project Manager• Dr Jane Riddle – GP Advisor• Yvonne Storey – Communications• Richard Copeland – Head of Clinical Services• David Campbell – Chief Pharmacist• Sandra Gray (Director, Age UK) – Patient

Advocate• John Connolly (Age UK) – Patient Advicate