What was the issue you were addressing or working on?
Review the council medication policy to ensure robust processes were in place for carers managing and administering medicines.
Due to shifting the balance of care, more patients with complex health needs are being looked after in the community therefore there is a need for specialist pharmaceutical care input, normally only available in the hospital setting.
What you did?
The Change Fund has facilitated joint working between health and social services resulting in a local authority medicines management policy which is fit for purpose. Over 1000 care at home staff (including private providers) have been trained on medicine management which ensures assistance with medication is safe and person centred. Also, the Change Fund has allowed the testing of reshaping pharmaceutical care for older people by covering the costs of bringing a hospital based care of the elderly specialist pharmacist into the community setting.
Case Study –
Care at home staff reported concerns about the health of Mrs A, a house bound lady in receipt of a homecare package for personal care, recently discharged from hospital. Her behaviour had changed and she was hallucinating. The integrated care and enablement team pharmacist visited Mrs A’s home to complete a medication review and made recommendations to Mrs A’s GP to reduce the dose of her medication which was causing hallucinations. She also counselled Mrs A on her warfarin therapy and arranged monitoring via the district nurse service. Mrs A’s requirement for assistance with medication was reassessed, as level 3 assistance, by the home care manager. The GP practice was contacted to record level 3 assistance on Mrs A’s patient record and the community pharmacy agreed to provide 28 day MAR charts to allow the care staff to record administration of Mrs A medication. Mrs A’s hallucinations stopped, her compliance with medication improved and a hospital admission, due to the adverse effects of medication, was avoided.
What were the outcomes - benefits or otherwise?
The outcome for Mrs A was that she remained safely in her own home, with input from a clinical pharmacist and safer administration of medicines by a trained carer.A hospital or care home admission was avoided.
This case was a good example of how successful integration of health and social care services can shift the balance of care and ensure safe and effective management of medicines. Care staff can now recognise when medicines are not being taken correctly or maybe causing side effects and can assist people to take their medication safely to achieve full benefit from their medication. This reduces the number of unnecessary hospital admissions, caused by medicine misadventure and by helping people to improve their compliance with medicines it reduces the medicine waste costs.