Supporting Structured Medication Reviews Care Home – Overview of Deprescribing in Care Homes

We’re sure you’ll be aware of the Overprescribing Review that has recently been released. With that in mind, there has never been a better time to discuss Structured Medication Reviews in Care Homes. This podcast is taken from Lelly Oboh’s seminar at the Clinical Pharmacy Congress. Lelly is a Consultant Pharmacist for Care of Older People. She shares her insight into Supporting Structured Medication Reviews Care Home; an Overview of Deprescribing in Care Homes. For further information on the topic, check out our upcoming webinar on Care Homes: SMRs, End of Life, Multimorbidities and Deprescribing.

 

This podcast covers: 

• Why deprescribing is important in care homes
• How does it fit into Structured Medication Reviews 
• What can you do as pharmacy teams to drive medicine optimisation in care homes? 

In particular, Lelly will be focussing on: 

• Care home residents: Context
• Polypharmacy and deprescribing
• SMR process fit for purpose with Pharmacy teams leading medicines optimisation

About care homes

People go into care homes when they are unable to cope at home on their own.  There are different types of care home including nursing, residential, dementia and frail elderly.  82.5% of residents are 65 years or over with the average age being mid-80s.  

The most common conditions in care homes are dementia, stroke, degenerative neurological conditions, advanced cardio-respiratory disease, cancer and painful arthritis. Many residents are frail and vulnerable with complex health and social care needs and a relatively short life expectancy.  

Lelly looks at health needs and medicine use among older people in care homes. 

Polypharmacy 

Polypharmacy is defined as prescribing or taking too many medicines. This may be due to the number of medicines, or fact that they take more than what is clinically required. It is associated with poor patient outcomes, increased adverse drug events, inappropriate hospital admissions, increased healthcare costs and poor medicines adherence.  

Lelly discusses the complex, interconnected drivers of polypharmacy. She emphasises the need for everybody to contribute to reducing polypharmacy. Clinicians need clinical and advanced communication skills, tools, patient centred approaches and MDT intelligence to address the issue.  

Deprescribing 

Deprescribing is defined as the complex process required for the safe and effective cessation (withdrawal) of inappropriate medication. It takes into account the patient’s physical functioning, co-morbidities, preferences and lifestyle.  

Lelly explains that it’s important to use patient-centred language. Avoid saying that they’re taking too many medicines. Instead, explain that you are trying to find the right amount for them. Instead of talking about “stopping your medicines”, Lelly focusses on the trial and review process to find out whether stopping them will make the patient’s symptoms better. 

Multidisciplinary teams involved with polypharmacy in care homes

There are a multitude of people who may be involved in polypharmacy in care homes, with the patient at the centre. Around them there may be a GP pharmacist, relatives, care home staff, nurses, geriatricians, community psychiatric nurses, social care providers and a multitude of other people. 

When dealing with a patient with complex needs, the environment in a care home will also be complex. There are rules in place and teams that all have a different agenda. It is worth being aware that the priorities of each person involved may be conflicting. However, everybody needs to pull together to make sure that what’s best for the patient is the focus. 

Patient centred Structured Medication Reviews

Structured Medication Reviews are comprehensive, clinical reviews of a patient’s medicines along with detailed aspects of their health. They should be carried out for people with complex or problematic polypharmacy and delivered by facilitating shared decision making conversations with patients. The aim is to ensure that their medication is working well for them. Lelly talks through a useful chart that summarises the SMR on a single page. 

A case-based approach to learning is often used in MORPh webinars. Lelly explains the case of an anonymous 75 year old female care home resident in a dementia unit. She uses this patient to talk through the process of conducting a Structured Medication Review.  

Further information on Structured Medication Reviews

At present, structured medication reviews are very topical and with good reason. The overprescribing review has led many of us to think about the necessity for SMRs both in care settings and within the community. MORPh provide regular, free training on a variety of topics. Check out our list of upcoming webinars to find the right one for you. Topics include:

• Structured Medication Reviews in Primary Care
• Pain Management in Primary Care
• Care Homes: SMRs, End of Life, Multimorbidities and Deprescribing.