Cardiff University researchers found that even in the best performing care homes, one resident was likely to be effected by four errors in the management of their medicine per week – and in the poorest performing homes this figure rose to 55 per week for one resident.
The research identified 23 types of error being made by care homes using traditional paper-based medicine administration record (MAR) charts, including a resident’s medicine dose not being recorded on charts, no record of the time a dose was given to a resident and actual medicine stock levels not matching those recorded.
However, when care home staff switched to using a technology-based system for managing medicines 21 of these 23 errors were eradicated, and another reduced by 88%. The remaining error related to GP prescribing instructions which neither the care home nor the technology could influence.
The in-depth study, which investigated 30 care homes in South Wales, was funded by the Welsh Government’s Health Technology and Telehealth Fund to discover how technology can both reduce improve resident safety by better care home medicines management and reduce medicine wastage.
The study offers the most significant research into medicines management in care homes since the Department of Health‘s “Care Home Use of Medicines Study” report in 2009.
Researchers at the university’s School of Pharmacy and Pharmaceutical Sciences compared MAR charts with a technology-based system for managing medicines which enables staff – via barcodes using a hand-held device – to identify each resident, and ensure his/her prescribed medication is correctly selected and administered.
Lead researcher, Dr Mat Smith, said:
“The management of medicines in care homes is notoriously difficult. There are significant challenges associated with safety, quality and accountability in medicines administration and record keeping, with serious threats posed to the vulnerable patients in our care homes
“Our evaluation has shown that many of these risks can be reduced by implementing the system and enabling pharmacists to make proactive and consistent interventions, which ultimately have a positive effect on patient safety.
“Furthermore, the evaluation has shown that millions of pounds could be saved by making informed decisions on stock levels and reducing the amount of medicine that goes to waste.” Amy Curtis, registered manager at Tower Hill Care Home in Penarth, which uses the technology: “Medication rounds are more efficient and take less time now. Staff have peace of mind in knowing that the new system helps them to ensure that all of the important tasks associated with medicines administration are completed and our residents receive their medication safely and in a much more personalised way.”
Those 16 pharmacists who participated in the study found that they had, on average, to intervene on 80% of prescriptions for the care homes they supplied. Half of such interventions were to double check a prescription against the resident’s current records held at the pharmacy before it was dispensed, 20% were checks of new medicines that did not match those on a resident’s record at the care home and 10% were related to new prescriptions that replaced or interacted with existing medication.
Based on the number of returned medicines and the overstocks seen in care homes during the trial period, wastage for the 26,000 care home beds across Wales was estimated to be between £6 million and £12 million each year.
If the technology was applied across Wales, it could save between £3.2 million and £4.6 million annually, the researchers stated. Wales Health and Social Services Minister Mark Drakeford said: “This new way of working is improving the quality and safety of care within care homes and reducing waste – not just wasted medicines but also wasted staff time.
“Ordering and managing medicines in a care home can be a full-time job, which is time that could be better spent caring for residents.”
Chair of Beacon Digital, Professor Clive Bowman, said: “The Welsh Government-supported Beacon Digital Healthcare project has successfully shown that in addition to improving safety, modernisation through technology can reduce waste and facilitate the development of professional support by pharmacists for care home residents.” The research was presented at a symposium at the Cardiff School of Pharmacy and Pharmaceutical Sciences on Wednesday 27th January.