Multidisciplinary review of medication in nursing homes: a clinico-ethical framework Northumbria Healthcare NHS Foundation Trust

his project is featured in our Power of People series of short films, which offer a unique and moving take on how the lives of people using health services and their families can be improved through the determined efforts of people working in health care. 

The Northumbria Healthcare project aimed to reduce the amount of medicines prescribed to older patients in care homes unnecessarily and to involve patients and their families or carers in decisions about prescribing and de-prescribing. It was also designed to build evidence about ethical decision making in prescribing.

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

1. Is the medication currently performing a function?
2. Is the medication still appropriate when taking co-morbidities into consideration?
3. Is the medication safe?
4. 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'.
• Net annualised savings of £77,703 or £184 per person reviewed.
• For every £1 invested in the intervention, £2.38 could be released from the medicines budget.

Challenges

One challenge the team faced was getting GPs released from their practices to attend review meetings. They tested a range of ways for GPs to be involved, but found that direct involvement was most valuable.

Supporting dissemination

This project was given further support through a Spreading Improvement award to help disseminate learning and maximise the impact of the approach across the health service at a local, regional or national level.

Funding was used to further disseminate and embed the Northumbria Shine care home project across the local health economy, as a result:

• a commissioned service across Northumberland  will offer structured reviews to 1,000 care home residents per year
• a video was produced of the key messages from the project such as how to undertake a medication review and how to involve residents in decisions about them
• learning from the Shine project helped to create a guide on undertaking medication reviews within a shared decision making framework, a review of psychotropic agents, as well as a care home service specification for North Tyneside general practices

The team are currently looking into assessing the barriers and facilitators to undertaking capacity assessments by practitioners undertaking similar review developed during the Shine project.