Sharing decisions with care home residents

Improving quality, reducing risk and saving money can be done through shared decision making with care home residents and their families.

Three years ago we started our innovative care home project where we gave residents an equal say in decisions about medicines.

By involving residents and/or their families in decisions about medicines we demonstrated an improvement in quality, reduced risk of harm from medicines and efficiency savings; considerable savings from the medicines budget, reduced waste and nurses spending less time administering medicines. That project is now a service across Northumberland (and has been adopted by other parts of the UK).

The review process involved examining primary care, care home and secondary care notes to answer four 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?

Who was involved The medication reviews were conducted by clinical pharmacists, with the findings discussed by multidisciplinary teams which included care home nurses and GPs as well as patients, families and carers where this was possible. Day-to-day project management was carried out by the trust’s transformation team.

Outcomes 422 reviews carried out in 20 care homes. 1,346 interventions, most of which involved stopping medicines. An average of 1.7 medicines stopped for every resident reviewed. The main reasons for stopping medicines were 'no current indication' or 'resident requested to stop' .

The Health Foundation (who funded our Shine project) launched the first of five films about quality improvement initiatives. A clinico-ethical framework for multidisciplinary review of medication in nursing homes. Here's our story... http://www.health.org.uk/pills

More information about our project can be found here:

http://www.health.org.uk/programmes/shine-2012/projects/multidisciplinary-review-medication-nursing-homes-clinico-ethical
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