service redesign care home services

Service RedesignCare Home

ServicesPaul Jerram

Head of Medicines ManagementIsle of Wight CCG

The Health & Care of Older People in Care HomesJuly 2000• A comprehensive interdisciplinary approach• A report of a joint working party• Royal College of Physicians• Royal College of Nursing• British Geriatric Society

Causes of Concern• Inappropriate usage of prescribed medication has

been demonstrated in care homes. SEVERAL STUDIES HAVE SHOWN THAT 20-25% OF CARE HOME RESIDENTS RECEIVE AT LEAST ONE INAPPROPRIATE PRESCRIPTION

• Millard et al found that only 25% of GPs in nursing homes regularly reviewed the medication of each resident.

Recommendation

• To introduce a specialist pharmacist for homes (and medication review of the elderly and specific high risk populations)

Analysis of Authorised Repeats for Medication & Dressings Before Review

Minor conditions54%

Dressings22%

Other drugs24%

Project •Following medication review, trained nurses, working to a protocol, can treat residents for minor conditions and use appropriate dressings without referral to a GP

Six Months Later• Improvement in prescribing against a number of

quality indicators• Improved medication regime for residents• Reduced workload for GPs, care home staff &

pharmacists• Reduction in cost of medication & dressings• Empowerment of nurse clinical team• Increased remuneration of pharmacists

Effect on Laxative usage26

21

1.10.2

3

0.5 0.9 0.5

0

5

10

15

20

25

30

Lactulose Senna Glycerin Supps Microlax

Aver

age

num

ber o

f dos

es g

iven

per

pat

ient

per

28

days

Before

After

Effect on Medication & Dressing Costs

4.433.65

11.23

19.31

1.52 1.21

8.21

10.94

0

5

10

15

20

25

Nurse managed OTC drugs Dressings Named patient drugs Total

Cos

t in

£s p

er p

atie

nt p

er 2

8 da

ys

BeforeAfter

Service Redesign• Brainstorm how we may improve existing services• Select most appropriate updates• Test concept and pilot• Evaluate• Roll out

Updates• Patient passport• Bar code patients• Remote access to medical records• E communication/records replaces paper• Increased patient safety via Radar/scheduled and

ad hoc monitoring• Proteus ingestible sensors for compliance check in

non care home patients• Carer or patient self monitoring

Patient passport

Patient Passport

Viewing other results

HELIUS PROJECT

HOME HYPERTENSION MONITORING PROJECT

The Isle of Wight is already introducing the innovative Patient Passport , a service that allows the healthcare team access to the patients health records safely, securely and efficiently.It allows access to the ‘essential aspects’ of patients medical records:

• Clinical Conditions

• Medications & Allergies

• Blood Results & Investigations

• Health Plans