The challenge to improve medication safety in care homes

A multidisciplinary group of senior healthcare leaders and care home managers have been working together to try and solve a big problem: how to stop the high rates of medication error in care homes. These errors are putting vulnerable older people at risk.

A strong call to action

Medication safety in care homes is an ambitious cross-sector partnership project. The partnership was formed to try and address some of the issues raised by the Care homes’ use of medicines study (CHUMS) and ongoing concerns about safety and standards related to medication prescribing, administration and management in care homes.

The CHUMS report was published in 2009, revealing unacceptable levels of medication error. The study showed that care home residents take an average of eight different medicines every day. On any one day, seven out of ten residents experience mistakes with their medication, ranging from doses being missed or given incorrectly, to the wrong drugs being given out. In some cases these errors have the potential to cause very serious harm. 

A report into the use of antipsychotic drugs to treat people with dementia in care homes was also published in 2009, revealing unacceptable levels of prescribing.

These two studies formed a strong call to action to improve the safety of medication in care homes to protect vulnerable older residents.

A unique collaboration

Susan Went, a Health Foundation Improvement Fellow, initiated the early work to develop the project. She went on to lead the work as Joint Project Director alongside Des Kelly, Executive Director of the National Care Forum who represented the Care Provider Alliance.

‘We knew that the issues raised by these reports could only be resolved by all professional groups taking shared responsibility’, she said. ‘Only a partnership between residents, their relatives, care homes, and health professionals will tackle this problem.’

In 2010, the Health Foundation, together with the Royal College of Physicians, the Royal College of General Practitioners and the Royal College of Psychiatrists, began working in partnership with the care homes sector and Age UK to build a better understanding of the problems and their potential solutions. This included holding focus groups with family and carers of people living in a care home (with feedback published jointly by the Health Foundation and Age UK in their Making Care Safer report). 

This work led to the development of a formal partnership project, funded by the Department of Health, which ran throughout 2011. Representatives from a range of professional bodies, plus a number of health and social care professionals currently working in and with care homes were invited to join a working group which met formally four times over the year.

Collaborative improvement methodology

Working in small task groups, participants pooled their knowledge and expertise to try and develop a range of practical tools which would help residents, doctors, pharmacists and care home staff to reduce the incidence of medication errors. They used small cycles of change to develop their ideas into working prototypes.

The prototype tools include:

• a residents’ charter
• a summary medication record, designed to be held by the resident
• a leadership guide
• a training guide for employers and a learner’s workbook
• a set of tools for identifying residents with deteriorating symptoms and for using homely remedies
• top ten tips for prescribing
• a framework for making the best use of medicines across all settings.

Des Kelly says it’s this ‘open space methodology’ which worked so well. ‘Mutual respect for different professional perspectives enabled the working group to produce practical materials with the potential to make a positive difference for people living in care homes’.

This is echoed in feedback from senior leaders involved in the work. Helen Gordon, Chief Executive of the Royal Pharmaceutical Society said: ‘There are a whole series of new discussions opening up as a result of this collaborative. It is having a much wider impact. It’s a great example of how professional bodies can and should work together.’ 

Next steps for the project

Phase two of the project will run throughout 2012 when the prototypes will be formally tested across a range of different care home settings.

‘Rigorous testing will provide evidence about how well the tools address problems and how they can improve medication safety. We then hope our successful improvements can be rolled out on a larger scale across the sector, improving the quality and safety of care for all care home residents’, says Des Kelly.

Find out more

'Medication safety in care homes' is a partnership project led by the National Care Forum (on behalf of the Care Provider Alliance) working with The Royal College of General Practitioners, The Royal College of Physicians, The Royal College of Psychiatrists, The Royal Pharmaceutical Society, The Royal College of Nursing, the Health Foundation, and Age UK.