During 2021-22 Structured Medication Reviews became a focus for priority vulnerable groups, which in Cumbria included residents in care homes. In Eden Primary Care Network (PCN) Cumbria there are 7 care homes and 10 General Practices, with Medicines Optimisation support provided by directly employed pharmacists, PCN pharmacists and pharmacy technicians and NECS Medicines Optimisation Specialist Pharmacist (MOSP)/technicians. At that time, given the workforce and skill set it was decided to align reviews to work from practices into the care homes with the frailty team (PCN pharmacists, technicians and care co-ordinators), responsible for the greater proportion of reviews. Support from the MOSP who already had good working relationships with 2 of the practices and associated care homes was provided across 4 of the care homes.
The work began in 2021-22. It became apparent with a natural ongoing turnover of residents, and time pressured care home staff, that reviewing medications ‘little’ and ‘often’ would be a more manageable and sustainable way to ensure ALL patients received a Structured Medication Review. During 2022-2023, aiming to meet the SMR01-D target – Percentage of permanent care home residents aged 18 years or over who received a Structured Medication Review, patient reviews were targeted to review during or close to their birthday month, or if they were a new resident, to within 2-3 months of registering with the care home. Reviews were broken down to 2-4 at a time and scheduled to fit best with availability of carers responsible for the patients on duty the day of the review.
For practices the MOSP covered, an achievement of 100% of permanent care home residents aged 18 years or over received a Structured Medication Review.
In Practice 1, 23 patients were reviewed with 50 interventions made.
In Practice 2, 56 patients were reviewed, with 130 interventions made.
Common interventions: 18 patients (23%) had Medicines Administration Record (MAR) updated with allergies status to match surgery records, 9 patients (12%) had changes to paracetamol dosing based on patient weight. 6 patients had DOAC doses checked. One patient identified as taking Apixaban 5mg daily was reviewed and the dose amended to Apixaban 5mg twice daily.
Embedding Structured Medication Review around birth month is a manageable way to review residents’ medications with care home staff. There were still difficulties with short staff/illness/Covid impacting on reviews during 2022-2023 with some sessions needing to be rearranged.
Other common actions were blood pressure checks and arranging blood tests that were due/overdue.
Communicating and actioning medication changes to community pharmacy/ care home was multidisciplinary. Practice teams cascaded information and the MOSP checked with the home at next set of reviews that the changes were in place. Use of standard template letters/documents helped ensure correct information was documented and there was an audit trail. Examples of clinical benefits to patients: Patient A was experiencing diarrhoea as likely reintroduction of metformin. A change to the modified release formulation resolved this. Patient B had dose of omeprazole reduced. Patient C - Discussions were held with family members around falls and fracture risks for potentially starting bisphosphonate medication.
