A clinico-ethical framework for multidisciplinary review of medication in nursing homes Wasim Baqir...
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Transcript of A clinico-ethical framework for multidisciplinary review of medication in nursing homes Wasim Baqir...
A clinico-ethical framework for
multidisciplinary review of medication in nursing
homes
Wasim BaqirOn behalf of the Shine Care
Unacceptable Patient Experience
Excess inappropriate
medicines
Lack of structured review
Lack of patient involvement
Our objective
Optimise medicines use incare home residents…
…ensuring that residents or their family are fully involved in any decisions around prescribing and
stopping medicines
Key Learning
• Not all patients have the capacity to make complex decisions – However, patients should have a say– Patient Involvement Framework
• MDT Model– One size does not fit all, but…– Pharmacist, Care Home Nurse, Patient are key– GPs, POAS service
Key Results
• 362 patients reviewed– 945 interventions – 54% (512) stop medicines in 219 patients (61%)– Start medicines, dose changes, dose forms,
monitoring, etc.• Drugs stopped because– Unnecessary– Safety– Unwanted
Key Results• 362 patients reviewed
– 945 interventions – 54% (512) stop medicines in 219 patients (61%)– Start medicines, dose changes, dose forms, monitoring, etc.
• Drugs stopped because– Unnecessary– Safety– Unwanted
• Financial Benefits– £55,000 saved on prescribing budget– Less nursing time to administer medicines– Reduced medicines waste
Family Perceptions
“I think we should be notified if something was going to be stopped. [pharmacist] discussed about
taking her off a Statin. But at the minute I think she is happy and has really good quality of life, I
don’t think she should be taken off things without consulting the family with a good reason for her
to be taken off them”
“There is no point people being on things
unnecessarily. You don’t need to be on them, why be
on them”
What next?
• Sustain– Business case to local CCGs– Local adoption by some practices– Adoption by neighbouring CCGs
• Spread– Local marketing– National awards– Publication– Health Foundation
Our Team• Wasim Baqir – Project Lead• Annie Laverty (Director of Patient Experience) • Prof Julian Hughes (POAS/Newcastle
University) – Clinical Lead• Nisha Desai/Steven Barrett – Clinical
Pharmacists• Joanne Mackintosh – Patient Experience• Peter Derrington – Project Manager• Dr Jane Riddle – GP Advisor• Yvonne Storey – Communications• Richard Copeland – Head of Clinical Services• David Campbell – Chief Pharmacist• Sandra Gray (Director, Age UK) – Patient
Advocate• John Connolly (Age UK) – Patient Advicate