Pharmacists based within care homes make them safer for residents
By: Communications
Research involving the University of East Anglia (UEA) has shown that basing pharmacists in care homes makes them safer for residents.
The Care Home Independent Pharmacist Prescriber Study (CHIPPS) trialled onsite pharmacists in dozens of care homes across the UK, including in Norfolk. Evidence from the study, published today in the BMJ, shows that onsite pharmacists reduce the risk of potential harm to care home residents from medicine.
According to the study, care home residents are routinely prescribed an average of eight or more medicines. Medicine use is considered to be one of the main areas of risk in care home settings by both the government and regulatory organisations.
One study cited in the BMJ paper says that 70 per cent of care home residents experienced drug errors daily.
The University of Leicester-led study says that there have been regular calls for interventions to help to improve the management of medicine in care homes.
Dr James Desborough, from UEA’s School of Pharmacy, said: “Most care home residents have many long-term conditions with a lot of prescribed medication. Traditionally, residents are registered to a GP who overseas their health needs.
“But we know that these medicines are not always managed effectively, which can result in errors and adverse effects for the residents.
“Historically, one approach has been to ask a pharmacist to pop in and do a one-off review periodically of residents’ medication. They would make recommendations but ultimately the GP had to authorise almost all medication changes and these types of services have been shown to have limited clinical effectiveness.
“We wanted to find out if pharmacists who are trained to prescribe medication in care homes, could ultimately help residents.
“So, we set up a new way of doing things – where pharmacists prescribers became part of the healthcare team working with the care home. This generally resulted in once weekly sessions where pharmacists worked with care home residents, staff and the medical practice to identify and resolve issues associated with medication.”
CHIPPS conducted a randomised controlled trial including 49 care homes across England, Scotland and Northern Ireland. The study also involved 25 care home trained pharmacist independent prescribers who were integrated into care homes to improve medicines management and safety.
According to the study, independent monitoring of pharmacist activities and review of unexpected resident deaths and hospitalisations found no safety concerns. Interviews with GPs, care home managers, carers and residents identified a high level of satisfaction with the service provided by the pharmacist independent prescribers. Analysis of the primary outcome of falls did not show a significant reduction, potential future harm from medicines was significantly reduced.
Dr Desborough said: “Our research shows that integrating pharmacists in to care homes is safe, reduces the drug burden for residents, and the risk of future adverse events.
“Both care home staff and general practice teams valued the pharmacists’ expertise and support, suggesting this service could reduce GP workload.
“The key to success was effective and regular communication with all parties which was a result of the integration into teams as opposed to a pharmacist just popping in, making recommendations, then leaving.”
Prof David Wright, from the University of Leicester, said: “I am delighted that the culmination of this six-year programme of work, undertaken by an incredible group of researchers, clinicians and patient representatives has produced this result.
“The CHIPPS model of care was very well received by all stakeholders. We believe that this was because both our training and model of delivery focused on the integration of the pharmacist independent prescribers into the medical practice and care home teams.
“This approach was supported by our process evaluation, which found that the intervention appeared most effective when the pharmacists were embedded within their local general practice.
“Furthermore, our pharmacist-led intervention was reported by some GPs to reduce their workload as they no longer had to routinely review and authorise large numbers of repeat medicines and the pharmacist prescribers assumed some of their care home responsibilities.
“The results support expansion of the current pharmacist role in care homes, to include prescribing and frequent visits, as it reduces future harm from medicines and helps care homes to improve their management of medicines.”
The study was led by the University of Leicester in collaboration with researchers at UEA and Norwich Clinical Trials Unit, the University of Aberdeen, Queen’s University Belfast, and the University of Leeds.
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