Prescribing & Medicines
Management
Issue no 1, p9-11
January/February 2003
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Prescribing & Medicines
Management |
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Features |
Hands on in Nottinghamshire: medicines management for the elderly
As most readers of P&MM will be aware, the National Service Framework for Older People set out some challenging targets for medicines management1: every patient over 75 years should receive an annual medication review; and those on four or more medicines should receive a six monthly review.2 Both these targets were to have been achieved by 2002.2
One PCT rises to challenge One primary care trust — Newark and Sherwood PCT in North Nottingham-shire —seized the opportunity to tackle these issues, with some promising outcomes. And through its participation in the first wave of the National Prescribing Centre's Medicines Management Collaborative programme other PCTs will be able to learn from its experience. Cara McCay, project manager, medicines management collaborative, described some of the medicines management team's initiatives. She explained that when she came into post, the trust did not have anyone dedicated to looking at the medication review targets in the NSF for Older People. The medicines management collaborative provided an opportunity to look at the whole area in a more focused way.
Workshops at lunch clubs Ideas for the scheme included a "hands on" medicines workshop for the elderly. What this entails is Ms McCay and a colleague visiting groups, such as lunch clubs for older people, inviting them to bring along their repeat prescriptions and medicines. The workshops start with a talk on getting the best from medicines. They also cover ordering repeat prescriptions, why the GP should know if medicines are stopped for any reason and advising on services available at community pharmacies. Technician Karen Robinson, soon to take over as project leader, then deals with specific queries on a one to one basis, looking at repeat prescriptions and checking that patients know the basic facts about their medicines. Ms McCay said that these workshops had been well received and that the trust hoped to continue them. This relatively simple approach had highlighted specific problems. Poor synchronisation of repeats had led to stockpiling of some medicines. For example, one patient was amassing thyroxine, as this was prescribed as a 90-day supply, with the rest of her medicines supplied for 28 days. Overuse of medicines had also been highlighted. The workshops had identified one patient using a salbutamol inhaler five times every hour. Compliance in sheltered housing In looking at concordance and compliance, the team had identified a particular problem relating to sheltered housing schemes. They had found that many residents in one sheltered housing estate were not taking their medicines correctly, including patients provided with monitored dose systems. Unlike staff in residential homes, sheltered housing wardens have no responsibility for the residents' medication. "These people seemed to be falling through the net, " Ms McCay said. The collaborative team arranged for primary care pharmacists to carry out domiciliary medication reviews for a small group of residents perceived to be at particularly high risk of medication related problems. The medicines management team is now looking at ways of ensuring that sheltered housing schemes receive regular medicines management support from community pharmacists. Medication review clinics With medication review being a key part of the NSF for older people, Ms McCay described how her team was promoting the use of a standard read code for recording medication reviews as a way of facilitating audit. As a next step the team developed templates for the GP clinical systems, in an attempt to standardise the content of reviews and to ensure they met the requirements of the NSF for Older People. Medication review clinics for the over 75s, run by community pharmacists at GP surgeries, are to be introduced in February 2003. The pilot scheme, which will provide around 400 medication reviews, will address cost and quality outcomes. It is hoped that if successful, the pilot will develop into a sustainable service in partnership with the PCT, practices and community pharmacists. All pharmacists had been invited to take part but, so far, the main response had been from those already linked with collaborative centres. However, Ms McCay was hoping for involvement with other pharmacists, as lines of communication between community pharmacy and the PCT team develop further. Ms McCay stated that a lot of the work around medication review had significant resource implications and reported that the medicines management team was feeding into the PCT's planning process in order to try and secure funding. She advised other facilitators involved with care of the elderly matters to link up with the person leading on the NSF for Older People for their area, so that they could feed into planning at a more strategic level. Although Ms McCay is soon to leave the trust, to take up a new post, she said that medicines management was now integrated into everyday life in the trust, rather than being regarded as a special project. A lot of the work was still developmental but she hoped that the changes already achieved had made a difference to many patients.
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