What was the issue you were addressing or working on?
- The pro-active identification and assessment of people at a high risk of experiencing an adverse drug reaction leading to hospital admission / re-admission, otherwise known as a polypharmacy medication review.
- Supported by improving communications and information transfer between hospitals and primary care with regards to medication.
What you did?
- A Pharmacist and Pharmacy Technician were recruited through the Change Fund to provide a pro-active Early Intervention service and a reactive Medicines Reconciliation service, to tackle the situation from both ends. Since 2012, the Project Leads initially developed referral criteria and pathways for the 2 services and liaised with stakeholders including GPs, Homecare, Community Pharmacies, Older Peoples Teams and Hospital Teams to engage and raise awareness.
- People offered the service are generally visited at home. This allows a fuller picture of medicine use and encourages the individual and their carer to be fully involved in any discussions / decisions around their medication, and to identify any support needed.
What were the outcomes - benefits or otherwise?
- Over 500 people have been referred to the Medicines Reconciliation service so far (as at September 2013), with the majority of referrals coming from the Homecare Rapid Response service. Evidence has shown the service to have successfully identified and resolved numerous issues, as well as providing support to people and their carers to manage their medicines effectively, leading to better outcomes.
- This includes individuals and their carers reporting feeling “more confident in managing my medication” as well as case examples of reducing the likelihood of adverse drug reactions which often lead to hospital admissions. Although it has not been possible to offer the service to all hospital discharges to date, it is hoped that the service could be expanded in the future, by raising awareness in the local hospitals.
- The Early Intervention service has delivered polypharmacy medication reviews to over 100 individuals to date. Initially, people were identified used SPARRA data and local intelligence at GP Practices, along with pro-active referrals from health and social care. The service is now targeting other vulnerable groups including sheltered housing residents and persons with dementia and their carers, as well as linking with third sector partners.
- The Polypharmacy reviews have consistently resulted in a reduction in the number of medicines people are taking, as well as reducing the number of high risk medicines that have been shown to cause avoidable hospital admissions. Individuals and their carers have reported being happier with the medicines they are taking, through having an improved understanding of what they are taking as well as improving medicines compliance in the process. All of these factors work together to reduce the likelihood of people being admitted to hospital due to their medicines.
The following Early Intervention case examples highlight these in greater detail:
- A – Checked patient’s blood pressure (BP) at visit – found to be low and significant postural hypotension on standing (though assymptomatic). Returned the following day to re-check and similar readings found. GP contacted and antihypertensive medicines reduced.
Impact: Potential for fall / collapse due to low BP could lead to injury, fractures and admission to hospital
- B – Patient with severe rheumatoid arthritis. Originally wary of service as under rheumatology consultant. However, during home visit was able to review and reduce analgesia, with no reduction in pain control. Also reviewed and changed inhaler + GTN formulations to improve adherence.
Impact: Adverse drug reactions minimised and ability to manage medicines improved.
Contacts - to find out more
Catherine Tully, firstname.lastname@example.org 07557 134618