1. Pharmacy in Care Homes Heena Khistria Care Services Pharmacist
Boots UK
21 September 2016

2. Overview How many people are in residential care in the UK?
What % experienced at least one error during their stay in care?
What % of residents have a fall yearly?
How many dementia residents prescribed antipsychotics die unnecessarily in the UK every year?
How much money does unused waste medicine from care homes cost the NHS per year?
426,000 elderly and disabled people in care homes across the UK
We live in an Ageing population where people are living for longer, along with that causes multiple health problems and often prescribed several medicines – average at the minute is 7 difference sorts of medication per patient.
70% residents experience at least one medicine error in their stay in care- The Care Home Use of Medicine study examined a random sample if 256 patients in 55 care homes in which 70% of residents experienced errors.
.Residents of UK Care homes for the elderly fall on average 2-6 times per year, in which 35% experience serious injury and 8% fractures
1800 dementia residents die unnecessarily as a result of taking antipsychotics they don’t need.
£50 million of NHS waste medicine comes from care homes- total amount £300 million.

3. How can the pharmacist help?
We want you have the right support and expert advice putting patients at the heart of everything we do. 

4. How Can Community Pharmacy Support Social Care?
Accessible
Support
Local
Family and Friends
Advice
Carers
The patient/resident/individual is always at the heart of everything we do in healthcare
But your local community pharmacy is nearly always at the heart of the community……….a real focus of the community
We cant underestimate the accessibility of community pharmacy to the vulnerable individuals in our communities
Or perhaps their friends and families who are helping them out or even carers or support staff working in a care home
Working alongside other healthcare professionals in a multi-disciplinary team to support the individual, regardless of whether they are in their own home, supported accommodation, Care home or Nursing home
We often talk about improvements to care but there are great examples of care already out there - sharing good practice
Person-centred Care
Integrated Care

5. Pharmacist Advice Visits
Not an audit or an inspection… constructive advice
A Pharmacy advice visit is a a structured visit focusing on supporting and advising the home with medicines management.
We are not their to catch you out saying you don’t do this, don’t do that, we are their to support and guide you by Sharing best practice
CQC want to see them
CQC want to see that you’ve taken the advice on board

6. Pharmacist Advice Visits
Section 1 – Policies and systems for managing medicines Section 2 – Ordering and receipt of medication Section 3 – Storage of medication Section 4 – Controlled Drugs
Section 1
medicines policy in line with NICE guidelines
dealing with side effects (patient information leaflets, BNF)
Medicine recalls
Transferring residents between care settings
Medication reviews
Section 2
Reducing waste – checking old stock levels and carrying forward- looking at the whole ordering process
Checking what medication you receive
Section 3
Medication trolleys
Fridges
Shelf life (e.g. eye drops, liquids)
Expiry dates
Section 4
Potential to cause serious harm
Keeping a register
Help to reconcile anomalies

7. Pharmacist Advice Visits
Section 5 – Disposal of medication
Section 6 – Clinical advice and medicines optimisation
Antipsychotic audit
Section 7 – Administration of medicine
Section 5
each resident should have no more than 1 litre of waste per month (100 residents = 5 x 22 litre bins)
Sharps/needles
Section 6
Look at all relevant information – test results, disease states, allergy, medication…
Swallowing issues
High risk medicines e.g. lithium, methotrexate, warfarin- ensuring blood tests ect have been carried out with examples.
Antipsychotic audit
Why do we do antipsychotic audit? – 1800 deaths due to unnecessary prescribing of antipsychotics.
1 in 3 people over the age of 65 develop dementia
90% of those have difficult behaviours- antipsychotics should be prescribed at a last resort for the shortest time possible and regular reviews should take place to ensure it is still required.
We check to ensure that do these patients need to take the antipsychotics for the BAPSD, Do they get the symptoms still? Do they gets side effects with the medication?
Section 7
Self medicating- are the relevent risk assesments in place?
Refusal of medicine- what is the correct procedure for this
PEG- has pharmacist advice been sought if medication is changed from its licensed preperation
Covert administration- is the required paperwork completed

8. Pharmacist Advice Visits
Section 8 – Recording the administration of medicine Section 9 – Homely remedies Section 10 – Care home staff training
Section 8
MARs – codes, missed entries, how to make a new medicine entry or change a dose etc
“as directed”- directions should be clear as otherwise errors can occur if the care home staff are not sure exactly how to apply/adminiser medication
Drug-drug interactions
Drug-food interactions
Topical MARs, warfarin MARs, insulin MARs, patch MARs…
Section 9
Policy
Storage
Documentation
Section 10
Are all staff upto date with training? Are their training certificates available to confirm this?
Errors or near misses? Are they dealt with correctlY? Are the learnings shared with rest of the team?
What training do we offer? Systems training and E-Learning on medicines handling and lots of other clinical modules which could be beneficial to care home stadd

9. Summary Supporting you to be at your best for your residents
Advice not audit
Preventing emergency admissions
Reducing waste
What I do is just the beginning…
We want to support you to be at your best for your residents.
Its advice not an audit.
Having pharmacist involvement can prevent emergency admissions, and reduce wastage.
What I do is just the beginning- by working together as a one healthcare team can do the best for our patients.

10. Contact details; heena.bhundia@boots.com
Thank you
Contact details; 10