An overview of the medication review project Improving quality and efficiency of care through patient centred treatment reviews

Our Pills film shows how work to reduce the number of medications prescribed to care home residents across North Tyneside helped involve older people in decisions about their care, improved their quality of life, and also saved money for the local NHS. Here we look in more detail at what the medication review project achieved and how the approach is now being used more widely to improve the lives of care home residents.

Led by Northumbria Healthcare NHS Trust, pharmacists and GPs worked with residents in 20 care homes, to help them understand and make decisions about the medications they were taking. The aim was to improve care for residents by involving them in decisions about their medications. At its heart, the medication review project was about encouraging shared decision making and making care more person-centred.

Why was a new approach needed?

Many older people in care homes take multiple medications to treat several health conditions, and often also take medications to help prevent other health conditions. Each drug can potentially have unwanted side-effects. The result can be that people are taking many medications every day sometimes without anyone having a clear overview of the impact this has on their quality of life and often without meaningful input from older people and their families.

Without regular review, medications may continue to be prescribed when they are no longer necessary. Sometimes medication review does happen when the opportunity arises, but it will usually only involve GPs and pharmacists. As a result, care home residents may have little say in the medications they are taking, families may not understand the decisions made about medication, and health professionals in care homes may not have the opportunity to contribute their observations and opinions.

What did they do?

The team tested a new medication review process. Structured reviews were carried out by clinical pharmacists, using notes from the resident’s care home, GP and hospitals visits. Their findings were then discussed at an appointment held at the care home which involved the resident, the resident’s family, a pharmacist and a nurse from the care home. Where possible, the resident’s GP also attended this meeting.  Together, they made decisions with each resident about which medications to stop, change or add.

How did it make a difference to people’s lives?

The results of the new medications review process are striking. An evaluation showed that it significantly reduced unnecessary prescribing across care homes and reduced the risk of harm to residents caused by medications. This improved the quality of life for residents, and cut down on the time and money wasted on needless medications. Care homes taking part in the project reduced the amount of medications prescribed to residents by 17%.

Impressive savings were also achieved. The new process helped to reduce the overall yearly medication budget by nearly £78,000 across the 20 care homes, equivalent to £184 per person reviewed. By reducing the number of medications nurses in the care homes administered, around an hour of care home nursing time per day was released.

Care home residents and their families generally welcomed the opportunity to be involved in decisions about prescribing and feedback shows that the reviews have had a positive impact on relationships between the families and the professionals involved in their care.  The new approach to medications review has also shown the benefits of involving older people in decisions about their treatment.

In the summer of 2015, the service was offered to an additional 3,000 care home residents across Northumberland.

The medication review project received funding from The Health Foundation in 2012