The medication review project worked in 20 care homes across North Tyneside, including Hadrian House, the nursing home featured in our Pills film. It has 50 residents including people with dementia and people with general nursing needs. We spoke to Sylvia Dixon, the Care Home Manager at the time, and Dr Pipin Singh, a local GP who was involved in the medication reviews at Hadrian House, and asked them about their experience of the project and its impact.
Getting people involved
Both Sylvia and Pipin first heard about the project from pharmacist Dr Wasim Baqir (Waz), the project lead, but neither needed persuading that it was a good idea.
For Sylvia, the burden of medications on residents was obvious. ‘Medication was an area of concern – not in terms of risk, but in terms of volume for the residents, time for the nurses, and I also realised families weren’t that involved – it was a great opportunity to do all of that.’
Previously, medication reviews for residents tended to be done more opportunistically, when a GP was attending for a particular issue, and without involving the family. For Pipin, the idea of introducing a formal process, which involved residents and their families in decision-making, was welcome. But he credits Wasim for really getting people involved. ‘I think Waz has been the big driver. Very innovative, very forward-thinking, enthusiastic – with that passion, he’s been able to get people on board, and make people realise how important the work is.’
Local engagement to make medication reviews a success
At Hadrian House, Sylvia laid the groundwork with residents, families and nursing staff. ‘That initial setting up time is massively important. Explaining to the families and facilitating the right environment. Explaining to the nurses that the review is holistic and their opinions and observations will be listened to. It isn’t just about the doctor coming in and crossing things off.’
Building in the time was important – arranging for GPs and pharmacists to have a dedicated session at the care home, for nurses to have time set aside, and families to be notified in plenty of time.
The impact of medication reviews at Hadrian House
Across the pilot, the amount of medication prescribed to residents was reduced by 17%, side effects for residents were reduced and money was saved. But there have been less easily quantified benefits too.
The time required for nurses to give residents their medication was also reduced – up to an hour a day – which meant nurses could spend more time with residents.
In care homes, having time to discuss a resident’s care together is rare. Bringing together a care home nurse, GP, pharmacist, resident and family member in this way had a positive impact on each relationship. This impact has had a lasting effect – nurses feel more valued by GPs, residents feel heard, family members have a better understanding of their loved one’s care. The new approach has also enabled better discussions and involvement from families around end-of-life care and advance care planning.
Pipin says, ‘It’s genuinely made patients feel more empowered about their health and I definitely think it’s caused a reduction in side-effects. There were a lot of patients who were on unnecessary medication and it’s improved quality of life. I think it’s allowed families an insight into how we think and why we do things the way we do. It’s improved our relationship with families as a result of that. Overall, a fantastically positive impact.’