Improving medicines safety in care homes

care home resident taking medicine

Our medicines management and optimisation team improved safety and care for elderly Wirral care home residents, helped to prevent falls and hospital admissions, and saved costs.

A team of pharmacists (equivalent to 1.5wte) were commissioned from our MLCSU Medicines Management Optimisation (MMO) team for two years using NHS England funding via the Medicines Optimisation in Care Homes (MOCH) scheme. The team:

  • Delivered medication reviews and completed medicine reconciliation
  • Supported care homes to reduce medication errors and develop medicine policies
  • Attended multi-disciplinary team meetings and advised on medication
  • Educated and trained care home staff and residents
  • Completed waste audits and advised regarding waste reduction.

The project resulted in improved safety and care for residents and also provided support during the COVID-19 pandemic.

  • 1,319 medication reviews and 146 medicines reconciliations were completed over the two year period resulting in 5,338 medication interventions and a cost improvement of £159,654
  • Residents and care staff were helped to understand medication regimes to reduce the risk of medication errors or adverse drug reactions and potentially avoid hospital admission
  • 443 interventions were deemed to have prevented a possible hospital admission saving £494,720 in admission costs
  • Rationalisation of medication regimes led to a reduction in medicine administration time for staff
  • Team support ensured prompt access to medicines such as those for end of life care
  • Advice following waste audits saved £3,714
  • Falls prevention support led to an improvement in the referral process for falls assessment that should reduce the risk of falls and hospital admission.

From the falls prevention perspective we find that the root cause of falling is often a case of combined side effects of polypharmacy, drugs that have been prescribed over long periods of time that are either no longer effective or doses are too high. I found our joint working very beneficial. For us, it enabled residents who were falling, whose risks had not been addressed by the home but identified by you, to be referred to us. It allowed us to highlight to you our concerns about medications, particularly those with high ACB scores which are known falls risks. Between us we were then able to inform the Quality Improvement Team who arranged a visit to the home… the benefits are more widespread than just the optimisation of medicines and [your service] plays a key role in improving the quality of life, care and safety of care home residents and improving the working knowledge of other teams involved with care homes around medicines management.
Julie Griffiths, Wirral Falls Prevention Service Manager

Assuring medicines safety

Our Medicines Safety Assurance Tool gives at-a-glance visibility of progress against actions required to ensure patient safety and helps commissioners and GP practices to provide assurance of compliance.

MLCSU Medicines Management and Optimisation (MMO) team working with GP Practices identified the burden on clerical and clinical staff to identify, share, action, and follow-up on medicines safety alerts. This led them to develop the Medicines Safety Assurance Tool or MSATTM that provides a systematic horizon scan of medicines safety information, and a means for commissioners and GP Practices alike to record actions, monitor implementation and ultimately provide assurance of compliance.

Over the last seven years, the team has developed and evolved the MSATTM into an at-scale innovative solution already utilised by 25 Clinical Commissioning Groups in the Midlands, Cheshire, Merseyside and Lancashire.

Its adaptability allows the tool to easily be tailored to local needs. The MSATTM is designed to meet the needs of individual GP Practices as well as Safety Committees, and provides effective governance and oversight to a larger network and organisation.

Each alert is listed with a recommended action and priority level via RAG status. The completed document is a permanent record that demonstrates compliance and gives assurance to patients, commissioners and regulators that care providers are meeting their NHS obligation to patient safety.

The primary purpose of the MSATTM is to reduce patient harm due to medicines. The data below shows by CCG the impact the MSAT had over a year:

  • 51 safety alerts were identified
  • 100% of the alerts were communicated in a prescribing newsletter to GPs, the CCG and community pharmacies
  • 75% of the safety alerts were implemented through decision support software
  • 70% of the alerts prompted a recommendation to complete a search of practice clinical systems.

As an innovative way to capture, record, and act upon safety alerts associated with medicines and medical devices, MSATTM can easily be shared at scale.

 “The MSAT is a highly valued resource for Wolverhampton CCG. MLCSU have worked to improve and develop this tool over a period of time to meet the CCG needs. The tool has proven to be an excellent checklist that helps the CCG take appropriate actions around patient safety. The tool is also used regularly to inform the content of our internal assurance committee report.”
David Birch, Head of Medicines Optimisation, Wolverhampton Clinical Commissioning Group