A care home pharmacy medicines optimisation initiative to establish and promote best practice in management of "when required" ("PRN") medication in care homes. To raise awareness and educate care home staff about the governance around "PRN" administration.
Conducted visits to care homes across the county to support medicines management, this revealed considerable variation in the use of "PRN" medication and the recording process. This inconsistency is the result of a number of factors including a lack of clarity around the purpose of the medication, the ways in which they are offered to patients & the lack of clarity in what needs to be recorded.
The patients ultimately benefit, as good practice of "PRN" medication management reduces the incidents around over & under medicating, reducing harm, enhancing management of chronic conditions when "PRN" medications are indicated and promoting efficient use of medicines.
The Care Home Staff are educated and empowered to manage this group of medication in accordance with best practice guidance; they are taking an active role and responsibility of monitoring use.
With the care home staff working with pharmacy to rationalise the use of "PRN" medication, GPs benefit as this reduces their workload and subsequent costs to the NHS.
The pharmacy care home team benefit as they are working in partnership with the care home staff, building relationships and throughout this project have had the opportunity to educate and promote autonomy and accountability of good practice of medicines management and optimisation of "PRN" medication within the care home setting.
An audit was conducted across Bedfordshire CCG localities to gain insight on the current practice of "PRN" medication across the care home setting.
The main outcomes were:
During the audit, 47% PRN medication were recommended by pharmacy intervention to be removed e.g. considering homely remedies as alternative
As a result of the audit, the following pharmacy interventions were implemented across the Bedfordshire CCG localities to promote and engrain best practice of "PRN" medications:
Development and launch of the "PRN medication flow chart" engaging with Key stakeholders including working with the council and service users. It was circulated to the GPs. The flow chart describes the best practice process of "PRN" medication management at point of prescribing. This flowchart will help to standardise practice with the care home setting and reduce variation across the localities.
The audit also prompted the development of guidance on expiry dates for emollients in the care home setting, this poster campaign engaged all care homes within the Bedfordshire CCG localities and helped to reduce wastage, reducing cost, promoting efficient use of "PRN" medications and educating care home staff on when it is appropriate to discard "PRN" medication.
