A domiciliary pharmacy service in Exeter has prevented 62 hospital admissions in a six-month period by optimising medication for housebound and frail elderly patients.

Ian Nash, a cluster pharmacist with North Devon Healthcare Trust, explained how the Exeter cluster pharmacy service undertakes clinical medication reviews and medicines reconciliation in patients’ homes in response to referrals from GPs and the community health and social care team. The service is delivered by a team of three pharmacists and two technicians and has the objective of enabling patients to manage their own medicines safely at home.

A three-month prospective audit of 112 patients was undertaken. The majority of the patients were aged 80 years or more and most were housebound. Many were taking more than 10 medicines and 85 per cent had some form of impairment that affected their ability to manage their medicines.

The risk of harm from medicines was assessed as ‘high’ or ‘extremely high’ in 76 per cent of patients at referral (using the NPSA risk assessment tool). At the final contact only 21 per cent of patients were at high risk of harm. The adapted RiO tool was used to assess the probability of avoidance of hospital admission. The scores, which were independently verified, showed that on 85 per cent of occasions hospital admission was genuinely avoided.

On this basis, 108 hospital admissions at a cost of £2,230 each could be avoided each year – a gross saving of £240,000 per year. Even allowing for staff costs of £140,000 per year, this would leave a saving of £100,000 per year, said Mr Nash.

“Ten per cent of the patients I visit live in utter chaos and much of the job involves reconciling medicines because the GP’s record is often not up to date.”

It has been concluded that the service offers a sustainable medicines management delivery model integrated into a multidisciplinary team and, as a result of this project, the service is to be retained.