Optimising Medicines, Enhancing Lives: Pharmacist-led Care Home Reviews Reducing Harm and Waste

Aneurin Bevan University Health Board

Project summary

This project established a structured, pharmacist-led medication review service for care home residents within Aneurin Bevan University Health Board, addressing high levels of polypharmacy, medicines-related harm and medicines waste. An unexpected and unique outcome of the project was the development of an OTC policy. An SOP has been developed, the health board policy updated and HCSW's trained to support Complex Care patients with access to over the counter medicines. This allows for equitable and timely access to community pharmacy services and medicines, returning control to the patient and restoring autonomy in care.

Using iterative PDSA cycles, a clinical pharmacist conducted comprehensive medication reviews, focusing on high-risk medicines, deprescribing, anticholinergic burden, compliance, and cost-effective prescribing. A standardised toolkit was developed to support consistent delivery, including templates, guidance, and training materials.

Baseline data was collected during PDSA cycle 1 covering a total of 252 residents. Across cycles 2 and 3, 89 residents were reviewed with 486 interventions. Key findings included significant safety issues: 50% of MAR charts contained discrepancies, 12% of residents had incorrect doses (including high-risk medicines), and 72% required additional monitoring. Interventions resulted in 38 medicines stopped, 19 initiated, 44 discrepancies resolved, and reductions of 64 daily administrations.

Patient outcomes improved through safer prescribing, reduced tablet burden, better compliance, and improved monitoring. The intervention also enhanced staff knowledge and confidence, supported shared decision-making, and improved multidisciplinary communication.

The project demonstrated system-wide value, including estimated drug savings (£6,428 annually), reduced waste, environmental benefits (20 kg CO₂ reduction), and release of GP capacity equivalent to 267 appointments.

The model has been successfully scaled, with another pharmacist trialling the toolkit in practice. A technician workforce model is in development, with a draft SOP to enable pharmacy technicians to contribute to structured reviews.

The approach has also expanded to community patients via the Complex Care Team, with a completed OTC policy and training programme to support equitable access to medicines and promote patient self-care. In addition, a PRN protocol and template has been developed to support HCSW's in the administration of when required medicines; reducing calls to nursing staff and saving clinical time.

This project demonstrates a scalable, sustainable model for medicines optimisation that improves patient safety, reduces waste, and supports integrated care delivery. Following implementation a further 28 residents have been reviewed.