Problems include: •Excess medicines (sometimes inappropriate) •Lack of structured review of medicines •Patients unaware of what treatment they are on and why
It is estimated that between 10% and 71% of elderly patients take medicines that are not suitable or have the potential to cause harm. Some patients experience minor side effects from medicines that have a profound effect on their quality of life. Whilst there are clear guidelines for starting medicines, there is less guidance for stopping medicines. This project, funded by the Health Foundation, involved an innovative care home medication review service, where residents and their families were involved in decisions about medicines. Fourteen care homes were recruited and multidisciplinary teams established. Detailed medication reviews were carried out, which involved questioning the appropriateness of prescribing, and ensuring that all medicines prescribed had a clear and documented indication, and were safe and clinically beneficial.
Together we asked the following questions: •Is the medication currently performing a function? •Is the medication still appropriate when taking co-morbidities into consideration? •Is the medication safe? •Are there medicines missing that the patient should be taking ?
Key results: •422 resident reviews carried out. •1,346 interventions made, the majority of which were to stop medicines. •1.7 medicines stopped for every resident reviewed. •The main reasons for stopping medicines were no current indication or residents’ request to stop. •The net annualised savings were £77,703, or £184 per person reviewed. •For every £1 invested in the intervention, £2.38 could be released from the medicines budget. •A 17.4% reduction in the medicine burden freed up staff time and enabled more contact with residents. •Early analysis suggesting that a multidisciplinary SHINE review is also preventing admissions: 172 admission pre- and 110 admissions post-SHINE intervention (p=0.004)
Challenges/learning One of the key concerns GP practices had was the capacity to release GPs to attend the reviews. Therefore four models of GP involvement were developed. Analysis showed that direct GP involvement in the reviews resulted in the greatest interventions Case study: Ethel, an 85 year old lady was bedbound as a result of multiple strokes and end stage dementia, she was unable to communicate or make decisions for herself. She was prescribed 11 regular medicines, including medicines to prevent a fracture, and medicines to prevent cardiovascular disease. Each day nursing staff would administer these medicines by lifting her head and pouring the solution into her mouth. This lady was also taking antidepressant, hypnotic and antipsychotic drugs medicines for agitation. On stopping her preventative medicines her agitation resolved and in time her clinicians were able to stop medication for her agitation.