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Service Redesign Care Home Services

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The Health & Care of Older People in Care Homes July 2000 A comprehensive interdisciplinary approach A report of a joint working party Royal College of Physicians Royal College of Nursing British Geriatric Society
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Service Redesign Care Home Services Paul Jerram Head of Medicines Management Isle of Wight CCG
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Page 1: Service Redesign Care Home Services

Service RedesignCare Home

ServicesPaul Jerram

Head of Medicines ManagementIsle of Wight CCG

Page 2: Service Redesign Care Home Services

The Health & Care of Older People in Care HomesJuly 2000• A comprehensive interdisciplinary approach• A report of a joint working party• Royal College of Physicians• Royal College of Nursing• British Geriatric Society

Page 3: Service Redesign Care Home Services

Causes of Concern• Inappropriate usage of prescribed medication has

been demonstrated in care homes. SEVERAL STUDIES HAVE SHOWN THAT 20-25% OF CARE HOME RESIDENTS RECEIVE AT LEAST ONE INAPPROPRIATE PRESCRIPTION

• Millard et al found that only 25% of GPs in nursing homes regularly reviewed the medication of each resident.

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Recommendation

• To introduce a specialist pharmacist for homes (and medication review of the elderly and specific high risk populations)

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Analysis of Authorised Repeats for Medication & Dressings Before Review

Minor conditions54%

Dressings22%

Other drugs24%

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Project •Following medication review, trained nurses, working to a protocol, can treat residents for minor conditions and use appropriate dressings without referral to a GP

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Six Months Later• Improvement in prescribing against a number of

quality indicators• Improved medication regime for residents• Reduced workload for GPs, care home staff &

pharmacists• Reduction in cost of medication & dressings• Empowerment of nurse clinical team• Increased remuneration of pharmacists

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Effect on Laxative usage26

21

1.10.2

3

0.5 0.9 0.5

0

5

10

15

20

25

30

Lactulose Senna Glycerin Supps Microlax

Aver

age

num

ber o

f dos

es g

iven

per

pat

ient

per

28

days

Before

After

Page 9: Service Redesign Care Home Services

Effect on Medication & Dressing Costs

4.433.65

11.23

19.31

1.52 1.21

8.21

10.94

0

5

10

15

20

25

Nurse managed OTC drugs Dressings Named patient drugs Total

Cos

t in

£s p

er p

atie

nt p

er 2

8 da

ys

BeforeAfter

Page 10: Service Redesign Care Home Services

Service Redesign• Brainstorm how we may improve existing services• Select most appropriate updates• Test concept and pilot• Evaluate• Roll out

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Updates• Patient passport• Bar code patients• Remote access to medical records• E communication/records replaces paper• Increased patient safety via Radar/scheduled and

ad hoc monitoring• Proteus ingestible sensors for compliance check in

non care home patients• Carer or patient self monitoring

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Patient passport

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Patient Passport

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Viewing other results

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HELIUS PROJECT

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HOME HYPERTENSION MONITORING PROJECT

The Isle of Wight is already introducing the innovative Patient Passport , a service that allows the healthcare team access to the patients health records safely, securely and efficiently.It allows access to the ‘essential aspects’ of patients medical records:

• Clinical Conditions

• Medications & Allergies

• Blood Results & Investigations

• Health Plans

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