Shaping pharmacy for the future
Pharmacists improving care in care homes in England
The Royal Pharmaceutical Society (RPS) believes it is time to change the way medicines are used in care homes.
Too many care home residents are taking medicines which are doing them more harm than good.
At a time when every pound of NHS resource needs to be scrutinised, we believe that a far more efficient system would have one pharmacist, as part of a multidisciplinary team, responsible for the whole system of medicines and their use within a care home.
We believe, and evidence shows, that this improves care, reduces NHS medicines waste and reduces the serious harm that can be caused by inappropriate use of medicines.
Find out more in The Right Medicine: Improving Care in Care Homes »
- Pharmacists should have overall responsibility for medicines and their use in care homes.
- One pharmacist and one general practitioner should be responsible for medicines in each care home ensuring coordinated and consistently high standards of care.
- Where a care home specialises e.g. in dementia care, the pharmacist should ensure they are competent to support the relevant clinical speciality.
- Local commissioners (such as Clinical Commissioning Groups or NHS England) should commission pharmacists to provide medicine reviews within care homes.
- Pharmacists should lead a programme of regular medicine reviews and staff training, working in an integrated team with other healthcare practitioners ensuring
Watch this video by the Health Foundation, explaining how the care of elderly care home residents can be enhanced through medicine reviews.
“We welcome this report and look forward to exploring the proposals further with all interested parties. Given that the use of a medicine is the most common intervention we make in the NHS, it is important that pharmacists are given the opportunity to use their skills to support care home residents and staff to maximum effect, as well as in settings such as GP surgeries and accident & emergency departments.”
Chief Pharmaceutical Officer, Dr Keith Ridge
“Making sure that older people are taking the right medicines should be an absolute priority . We know that increasing numbers of older people are on large amounts of medication, often for long periods of time, and with little or no opportunity for a full review of what they are using. There is good evidence to suggest that people on large numbers of medicines are often getting little if any benefit from some of them and that they’d be positively better off without others.
“For older people living in care homes, many of whom are coping with multiple long-term conditions and frailty, getting their medicines right is crucial to their wellbeing. We welcome the idea of having a pharmacist attached to every care home. We would also like to see discussions taking place routinely with older residents, helping to identify the best medicines for them as their needs change and helping them to manage any side effects.”
Caroline Abrahams, Charity Director at Age UK
“The NHS was set up to provide health care from the cradle to the grave. Yet from our National Helpline we hear very worrying trends regarding the care of older people. Our recent survey on swallowing difficulties (dysphagia) in care homes found that carers were compromising patient safety by changing how the medicine was administered, such as crushing up tablets, without understanding the consequences of such action. Clearly having a named pharmacist responsible for resident’s medication in care homes would dramatically improve patient safety and the effectiveness of the many medicines taken, not just for residents with swallowing difficulties but for all residents, by ensuring that they were taking the right medicines in the right way at the right time.”
Katherine Murphy, Chief Executive, Patients Association
“We are fully supportive of the RPS’s call for each care home to have a designated pharmacist. Pharmacists are one of the most under recognised and undervalued professions in the NHS, and pharmacy input into care homes can make a real difference to the quality of people's lives. It has been my experience that pharmacists have a detailed understanding of the interface between drugs and ensuring that side-effects are reduced by intelligent and informed prescribing – this is particularly important as the majority of people living in care homes have many comorbidities and are taking several drugs.”
Professor Martin Green OBE, Chief Executive, Care England
“With 70% of people in care homes estimated to have dementia, having a pharmacist on hand to support people with the condition to manage and review their medication on a regular basis would be a welcome measure. Many people with dementia live with other long-term health conditions and there is a danger that, without effective management, they could end up on a number of drugs which could interact negatively with each other, exacerbating the symptoms of their dementia. Having a visiting pharmacist in care homes has the potential to both save money and improve quality of life.”
Laurie Thraves, Senior Policy Officer, Alzheimer’s Society
“One in four beds in care homes are occupied by someone with diabetes. Many of these patients will have complex health needs, which may involve taking a number of different types of medicines, so having pharmacists working in care homes will help to ensure that the best choices are made around people’s diabetes and medicine management. This is really important because diabetes is a very serious health condition that, poorly managed, can lead to debilitating and life-threatening complications, both short-term and long-term, such as extremely low and high blood glucose levels, stroke, amputation and blindness. These complications can have a particularly devastating impact on older and vulnerable people.”
Simon O’Neill, Diabetes UK Director of Health Intelligence and Professional Liaison
“We welcome the opportunity to further develop the constructive and valuable relationship that GPs have with our pharmacist colleagues, in a way that can increase our patients’ safety and save the NHS money.
“Our patients who live in care homes are invariably living with multiple, long-term conditions, and as a result are often taking multiple medications, which can lead to health problems in itself. Managing polypharmacy effectively is key to ensuring our patients in care homes are kept safe and only taking medicines that they need to – this also reduces medicine waste, and at a time when the health service is running with scant resources, this is particularly important.
“With GPs and our teams under incredible resource and workforce pressures, the suggestion that pharmacists to take on some of the medicine management responsibilities in care homes is definitely worth exploring – and we thank the Royal Pharmaceutical Society for putting these propositions forward.”
Dr Maureen Baker, Chair of the Royal College of GPs
“The British Geriatrics Society has long believed in the benefits of regular medication review for patients with long term conditions. This is particularly important for frail patients who are more likely to be in residential care. The model where a pharmacist is part of the multidisciplinary team is an effective way of delivering this and should be routinely provided.”
Professor Stephen Jackson, British Geriatrics Society
“The Royal College of Emergency Medicine welcomes this report and the aim of ensuring every care home has an allocated pharmacist. Poly-pharmacy and unintended drug interactions are common features of the acute presentations of care home residents to hospitals and emergency departments. Utilising the skills and expertise of pharmacists to ensure optimum safe use of prescribed medicines will improve patient safety, diminish costs and reassure carers”
Dr Clifford Mann, President, Royal College of Emergency Medicine
"The Faculty of Old Age Psychiatry fully supports the model where a designated pharmacist with the relevant competencies is part of the multidisciplinary team supporting care home residents. Medication reviews are key to ensuring that residents are only on the medications they actually need. These reviews are particularly important for those in care homes who often have multiple long term conditions and are at particular risks of drug side effects and interactions which can negatively affect their mental health. We also agree with the focus the report puts on achieving a reduction in antipsychotic use where possible and having easy access to anticipatory medication at the end of life."
Dr Amanda Thompsell, Chair of the Faculty of Old Age Psychiatry
- Blog- Getting a Medicines Review in a Care Home
- Getting the medicines right report (transfer of care)
- Referral toolkit
- Multidisciplinary review of medication in nursing homes: a clinico-ethical framework
- Quick guides: transforming urgent and emergency care services in England
- Quick reference guide: Medication review
- Improving patient outcomes through the better use of multi-compartment compliance aids (MCA)
- Role of pharmacists in improving healthcare for people with dementia living in care homes
- Commissioning person-centred care for vulnerable groups – What role does pharmacy play?
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