The NHS could save £135 million a year through the widespread introduction of a pharmacist into every care home across Great Britain according to a new report to be launched tomorrow by the Royal Pharmaceutical Society (RPS). ‘The Right Medicine – Improving Care in Care Homes’ report concludes that pharmacist led medicine reviews in care homes can not only improve safety for elderly care home residents but also save the NHS money by preventing avoidable hospital admissions.
In response to the report’s findings, the RPS, Alzheimer’s Society, The Patients Association and Care England, have called for a pharmacist, as part of the healthcare team, to take charge of the whole system of medicines and their use within a care home to improve patient care, reduce the waste of NHS medicines and prevent the serious harm that can be caused by inappropriate medicines use in elderly residents.
Sandra Gidley, Chair of the RPS English Board said: “Care home residents take an average of seven medicines a day with some taking double or treble this amount. The number of drugs prescribed by hospital, community and out of hours care for multiple conditions can quickly mount up. Without a regular review of what’s still needed, this cocktail of drugs can cause poor health, a lower quality of life and costly unnecessary admissions to hospital.”
She continued, “Pharmacists can provide the solution by stopping the use of unnecessary medicines, upgrading residents to newer types of medicines with fewer side-effects and reducing the amount of wasted medicines. Having a pharmacist responsible for the use of medicines in a care home as part of the team of health professionals would also bring significant savings through regular reviews. The evidence is clear: now is the time for the NHS to act and improve the care of residents by ensuring a pharmacist has responsibility for the whole system of medicines and their use within a care home.”
There are currently 405,000 care home residents in the UK aged over 65[i] with approximately 97 per cent being prescribed at least one medication. Nearly three quarters are exposed to a minimum of one potential medicine administration error[ii]. The RPS estimates that pharmacist-led medicine reviews with residents and their families can save up to £60 million per year as a result of a pharmacist stopping, reducing, starting or changing medication[iii],[iv],[v].
Pharmacist-led medicine reviews in care homes have also been calculated to save £190 per resident by preventing avoidable hospital admissions caused by potential drug related adverse events.*5 When the RPS applied this cost saving to the number of elderly care home residents across the UK on at least one medication, it was estimated that over £75 million per year could be saved5.
Laurie Thraves, Senior Policy Officer at Alzheimer’s Society said: “With 70% of people in care homes estimated to have dementia, having a pharmacist on hand to support people with the condition to manage and review their medication on a regular basis would be a welcome measure. Many people with dementia live with other long-term health conditions and there is a danger that, without effective management, they could end up on a number of drugs which could interact negatively with each other, exacerbating the symptoms of their dementia. Having a visiting pharmacist in care homes has the potential to both save money and improve quality of life.”
The number and proportion of older people continues to rise, with over 11.4 million (18 per cent of the population) aged 65 and over in mid-2014, up from 11.1 million (17 per cent) last year[vi]. The number of older people using residential and nursing care homes rose by 21 per cent from 135,000 to 164,000 from 2005-13[vii].
‘The Right Medicine – Improving Care in Care Homes’ report will identify the key areas where pharmacists in a residential care home can improve the level of patient care and safety:
- Falls – each patient must receive a falls assessment on admission into a care home, and regularly thereafter, and a pharmacist should be involved in assessing falls risk from the medicines the patient takes
- Psychotropic medicines (those which affect a person’s mental state) – A quarter of elderly in care homes are prescribed antipsychotics[viii]. Pharmacists should play a key role as part of the multidisciplinary team in providing oversight of psychotropic medicines prescribed in care homes to ensure that their use is kept to a minimum.
- Medicines waste – An estimated £24 million is lost every year due to medicine wastage in care homes across England alone[ix]. If pharmacists have responsibility for medicines use in care homes this will help to solve the issue of waste medicines, improve efficiency and provide better health outcomes for care home residents.
- End-of-life care – advice about and access to end-of-life medicine should be formalised between prescribers, pharmacists and care home providers.
The RPS’s ‘The Right Medicine – Improving Care in Care Homes’ report can be viewed at http://www.rpharms.com/our-campaigns/pharmacists-improving-care-in-care-homes.asp from 23 February. *A qualitative assessment is made of the potential impact of each intervention with regard to the impact of that intervention preventing a hospital admission. A cost avoidance figure of £3,500 is attributed to each potentially saved hospital admission. This is based on the average length of stay for an older person presenting at A&E.
[i] Age UK estimate calculated from Care of Elderly People Market Survey 2013/14, Laing and Buisson, 2014. As referenced in Age UK (2015) Later Life in the United Kingdom Available at: http://www.ageuk.org.uk/Documents/EN-GB/Campaigns/CIC/Care_in_Crisis_report_2014.pdf?epslanguage=en-GB?dtrk%3Dtrue
[ii] Alldred DP et al. Care Home Use of Medicines Study (CHUMS) Medication errors in nursing & residential care homes ‐ prevalence, consequences, causes and solutions Report to the Patient Safety Research Portfolio, Dept of Health. Available at: http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/cfhep/psrp/finalreports/PS025CHUMS-FinalReportwithappendices.pdf
[iii] The Health Foundation. Multidisciplinary review of medication in nursing homes: a clinico-ethical framework. 2010. Available at: http://www.health.org.uk/programmes/shine-2012/projects/multidisciplinary-review-medication-nursing-homes-clinico-ethical
[iv] Bower S, Whiteside H. CHAMOIS project (Care Homes And Medicines Optimisation Implementation Service). Journal of Medicines Optimisation 2015 1:(1):18-24
[v] Butterfield L, Shah J. Care home medication review by clinical pharmacists across Brighton and Hove CCG. 2014. Available at: http://www.kssahsn.net/what-we-do/our-news/events/Care%20Homes%20Collaborative/Brighton%20and%20Hove%20pharmacist%20meds%20reviews.pdf
[vi] Office of National Statistics. Population Estimates for UK, England and Wales, Scotland and Northern Ireland, Mid-2014. Available at: http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk–england-and-wales–scotland-and-northern-ireland/mid-2014/index.html
[vii]Age UK. Care in Crisis report 2014. Available at: http://www.ageuk.org.uk/Documents/EN-GB/Campaigns/CIC/Care_in_Crisis_report_2014.pdf?epslanguage=en-GB?dtrk%3Dtrue
[viii] Child A et al A pharmacy led programme to review anti-psychotic prescribing for people with dementia. BMC Psychiatry 2012 12:155
[ix] YHEC/School of Pharmacy, University of London. Evaluation of the Scale, Causes and Costs of Waste Medicines. 2010. Available at: http://discovery.ucl.ac.uk/1350234/1/Evaluation_of_NHS_Medicines_Waste__web_publication_version.pdf