The Pharmaceutical Journal
Vol 280 No 7487 p114
2 February 2008

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Pharmacists can help support care homes for the treatment of the elderly

By Valerie Fox

The Commission for Social Care Inspection (CSCI) released a report in February 2006 that suggested almost half of England’s nursing and care homes fail to meet national standards on medication, with poorly trained staff and records not properly kept.

Dame Denise Platt, CSCI chairman, commented that giving the right medicine in the right doses at the correct time is critical, and the report noted there have been few improvements since a similarly critical report in 2004.

It concluded that expenditure on training did not have any impact on this area of quality and care homes were urgently recommended to review their practices in managing medication, to set up robust staff training programmes and work jointly on initiatives within NHS primary care trusts.

Not all PCTs commission such services from community pharmacy and in light of the recent Pharmaceutical Services Negotiating Committee publication, “Practice-based commissioning — a practical guide for local pharmaceutical committees” LPCs” (PDF 430K), this seems to be an area that could provide opportunities for community pharmacy to develop services to prevent hospital admissions, one of the three major areas that would receive high priority for funding.

I have been involved with providing medicines and training to care homes for more than 15 years, with medicines training for care workers coming high on my list of priorities. Having run a number of training sessions for care workers (originally based on the National Pharmacy Association model) I am qualified to comment that two tutorials each of three hours had little or no impact or relevance to care workers.

The carers, usually with no formal background training, were overwhelmed with the content and did not find it useful or interesting, with most participants attending simply to obtain a certificate.

Experience, gained with training over the years, has changed my training model to one that has proved successful with care workers.

I attend care homes on a regular basis to carry out training with small groups of staff covering appropriate topics (identified by them in advance, as being relevant to the residents needs at the time).

Training sessions are held in the care home over a staff break period for about an hour. Only one subject per training session is discussed, using evidence-based and National Institute for Health and Clinical Excellence guidelines, and staff receive a handout (no more than two sides of A4 paper) condensing the main points of the tutorial topics.

Recent topics that care workers have covered include Parkinson’s disease, Alzheimer’s disease, chronic obstructive pulmonary disease and asthma. Each training session covers some basic physiology, a description of the disease process, treatment aims and outcomes, and drug treatments and side effects to watch for.

It also covers ways in which care workers can become actively involved in the treatment process and there is an open forum for questions.

The section that many care workers really appreciate is the one discussing ways of becoming actively involved with the patient’s care.

A recent tutorial on Alzheimer’s disease covered determination of the Mini Mental State Score. Feedback on this from staff looking after Alzheimer’s patients was that patients achieved a higher MMSE score when they were conducted by the person who saw to their everyday needs and knew them, rather than by a healthcare professional, in which case they would become withdrawn.

Further, staff reported that patients with advanced dementia respond to music and old black and white movies, activities which seem to improve their quality of life. Included in this particular session was for care staff to be aware that the main side effects of drugs to treat Alzheimer’s disease are feeling sick, with cramps and diarrhoea, and that depression in dementia is common.

This information allows the care worker to be more sympathetic but also to inform GP if they feel the patient is depressed, so that treatment may be commenced.

Simply encouraging staff to spend time with these people improves the quality of life of the patient and allows greater job satisfaction for the carer.

A separate session on Parkinson’s disease discussed the way care staff could better look after these patients. These included encouraging regular exercise and movement to loosen stiff muscles, allowing sufferers to do more for themselves even if it does take a little longer and emphasising the importance of good nutrition.

Also highlighted was the carer’s role in reporting problems such as nausea, depression and constipation promptly to GP so they may be resolved quickly.

These training sessions are always attended with enthusiasm and interest. Feedback from care staff is that they felt more equipped to deal with medication queries and could have a real input in the care of their elderly charges. They have also felt empowered to voice any suspected medication problems on behalf of the patient, as many of their older patients are reluctant to complain or are unable to do so.

Tutorials addressing diabetes have been well received, giving an insight to care workers on the management of the condition, action and uses of drugs and the reasons for choice. An explanation was included of the different types of insulin available, local guidelines on frequency of blood glucose monitoring, and discussion on hyper- and hypoglycaemia.

Care staff were also informed that hypoglycaemia induced by an oral antidiabetic drug should be referred to hospital as a medical emergency, since the effects of these drugs can persist for many hours.

Things that most care workers do automatically in the course of a day’s work are highlighted in the training sessions as being valuable, giving validation to the care staff of the importance of their roles. This, along with basic information, gives them increased confidence to recognise potential problems before they become an emergency and to make life more comfortable for their patients.

Also, another positive aspect of these training sessions is that care workers become more likely to approach the pharmacist with queries, one becomes more involved and part of the team rather than a remote figure supplying medicines to the home.

Care workers are encouraged to attend medication reviews with the people in their care; their input is invaluable in developing more appropriate care plans for the GP to consider. Training also incorporates good housekeeping (since an audit of costs of returned unwanted medicines from care homes had shown them to be considerable).

Educating care workers about the costs of medicines wasted has, in my experience, dramatically altered the amount of returned medicines. Training, therefore, is also cost effective.

There is a saying that “a little knowledge is a dangerous thing” but I believe that a little knowledge and encouragement may save lives and can certainly increase the quality of life of vulnerable elderly people.