The Royal Pharmaceutical Society has called for pharmacists to be better utilised by care homes, saying it could make a huge difference to the quality of life of residents as well as the wider NHS. 

One pharmacist, one care home. That was the main recommendation made in a vision document published by the RPS in February. ‘The Right Medicine: Improving Care in Care Homes’ says that something has to change in the places where nearly half a million of the oldest people in our society live. The document champions pharmacists as being able to make the difference.

The RPS is not wrong in drawing attention to the issue. Research over recent years has shown that older people are simply not getting the care they require as they approach the end of their lives. The average number of medicines prescribed to care home residents is 7.2, but not all of this is warranted. An audit found that over a quarter of those on antipsychotics didn’t need them and, in nearly six in 10 cases, the risks of such drugs were considered to outweigh the potential benefits.

Given that polypharmacy has long been linked to an increased risk of falls, it is perhaps unsurprising that many people living in care homes suffer such incidents. Alarmingly, the figure has been put at 50 per cent of residents falling each year. Another paper has found that 35 per cent of falls result in serious injury, with 8 per cent causing a fracture.

The bad news doesn’t stop there. Take those who have gone into hospital as the result of a fall while in a home. Only one in 10 is discharged on the same medicines they were taking on admission. The risk of an adverse drug event has been estimated as 4.4 per cent for every drug alteration or change.

And even when back in residential care, these patients are not receiving the level of support they need, with a report showing that around 50 per cent of communication errors around medicines management occur directly between the home and community pharmacy.

Change needed

Clearly, problems beset many stages of a patient’s journey through primary, secondary and residential care, but one of the chief culprits is that so many individuals and organisations are involved. This, in turn, means that all too often no one person is responsible for the care of some of the most vulnerable individuals in the healthcare system. This, the RPS states, could be addressed by making one pharmacist, as part of a multidisciplinary team, responsible for all arrangements regarding medicines and their use within a care home.

Services provided by this pharmacist would include conducting an individual risk assessment when someone moves to a care home, to establish whether they are able to manage their own medicines and undertaking medicines reconciliation at the same stage, says the RPS. Once a year, or whenever a drug is started, stopped or changed, or a resident moves care setting, the pharmacist would review all the patient’s medication, and also conduct a falls assessment upon admission and at regular intervals. As a result of all these interventions, medication regimens would be rationalised, meaning adverse reactions and thus falls and hospital admissions would be substantially reduced.

Alongside this, the RPS believes that – with patient consent – pharmacists working in such a capacity should have full read and write access to health records. This, in addition to being a regular presence at the care home they are attached to, and an increased involvement in end-of-life and anticipatory medicines decisions, would promote higher quality, safer and more effective patient care, and provide support to care home staff, says the RPS.

It is worth noting that the paper’s recommendations are in line with those made in guidance on the topic published by NICE in 2014.

Wider benefits

Increased pharmacist involvement in care homes would have other benefits, says the RPS, such as helping to solve the issue of medicines waste. This, combined with the savings incurred as a result of a decrease in hospital admissions in this population, would pay for the service, the Society adds.

More use of pharmacists in care homes would optimise drug regimens

Such a vision, however, is not straightforward to put into practice. Enablers identified by the RPS include:

• Making one GP practice responsible for one care home
• Establishing a blueprint for commissioners about what good pharmaceutical care in residential homes looks like
• Drawing up a standard contract for use between homes or CCGs and pharmacists providing such services
• Putting in place better IT systems to improve the flow of information across both independent and NHS health and social care providers.

The Royal Pharmaceutical Society document can be found here. Views and comments on any areas that have been overlooked or how the work described can be taken forward should be sent to heidi.wright@rpharms.com.