Islington Pharmacy Reablement Service - Domiciliary medication reviews

Reablement is a goal-orientated package of care provided to appropriate individuals by Health & Social Services. These individuals are often on multiple medications for several long-term conditions and would benefit from a medication review and support from a pharmacist.

Anecdotal reports suggested that medication-related problems were commonly encountered during Reablement carer visits. These problems included; insufficient medication information provided on discharge from hospital, lack of assessment of patients’ medication-related needs prior to discharge, multiple supplies of different medication and service user inability to manage their medications independently.

In April 2012 a clinical pharmacist post was commissioned to conduct domiciliary medication reviews for this population. The aim of the service is to show that by providing proactive medication support through domiciliary reviews that therapy can be optimised, potential adverse effects can be avoided and individuals can be empowered to manage their medications.

Since the pilot began in April 2012 until 31st December 2014 203 domiciliary reviews have been conducted.Data from these reviews has been analysed until March 31st 2014 when 139 reviews had taken place.

As a result of these reviews 573 interventions have been recommended by the pharmacist. Categories of interventions include:

• Avoidance of adverse drug effects

• Optimisation of therapy

• Education and/ or counselling

• Lifestyle interventions

• Arranging supply of medications

As increasing service user independence with medication management was a key aim of the service a formal evaluation of service user opinion was conducted in April 2014 on a sample of individuals. Thirty-four service users who had been seen by the Reablement Pharmacist in the preceding six months were interviewed by telephone to ascertain their satisfaction with the service. The median age of interviewees was 74 (range 48-95 years); 62% were female. Overall, participants valued the service, and the pharmacist’s visit exceeded their expectations and promoted their independence with taking medication.

The project has had a positive impact on both the hospital and social services multi-disciplinary teams. Interventions are regularly feedback to in-house clinical pharmacy meeting, leading to discussions around how improvements can be made to aid the transfer of patient care and information from secondary to primary care. This has led to an active drive to increase the standard of discharge letters for all patients, reducing the chance of an error when patients transfer from care settings.

Within the social services team the Reablement pharmacist has fostered a greater understanding of how to manage medications appropriately in a patient’s home and how to support them to remain independent in their homes. Having an increased awareness of medication related problems will hopefully reduce the overall number of hospital admissions for the service. The success of having pharmacist input in the Reablement team has led to the expansion of the service, as capacity allows the pharmacist may now also conduct medication reviews for the social services REACH team, complex elderly integrated care teleconferences and AgeUK.
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