Transcript MAR chart reviews in care homes - PrescQIPP

Medicines Waste in care homes
Jane Newman
Pharmacist
MAR chart review
• Reviewed MAR charts
• At the same time:
o Looked at the medicines returned for destruction log
o Asked about the process for re-ordering meds
o Had a quick look at medicines rooms, in cupboards
and fridges
o In some cases also looked at the care homes
medicines policy
A common sense approach
Reference sources for MAR reviews
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UKMi Optimising safe and appropriate medicines
STOPP START toolkit
NHS Scotland polypharmacy guidance October 2011
Medicines and falls in hospitals guidance
MUST
BNF
Sources of Waste – and potential patient harm
1. Waste caused by the process of ordering, storing,
keeping account of and administering medicines to
residents
2. Lack of timely clinical review or clear directions,
leading to medicines prescribed historically being
continued for ever and/or given more frequently
than required
3. Expensive formulations
4. Individual items: dressings, sip feeds, inhalers,
creams, dispersible formulations, liquids etc.
Process driven waste
• Blistered ‘prn’s
• Creams: tub vs. tube or pump (1 month / 3 months)
• Meds not supplied in original packaging (No expiry
date)
• Fridge lines (over ordering)
• Care homes not carrying forward meds to the
next cycle
• Items not re-ordered by the home but supplied
nonetheless (GP systems)
• Quantities rounded up to fit pack size
‘PRN’
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Meds given continually
No prn on dosage instructions
Lack of reason for ‘prn’ on dosage instructions
Care home staff unwilling to determine if a
prn medicine is needed
Any ‘prn’ medicines re-blistered into MDS will
inevitably lead to waste
Process driven waste: an example
One large care home (112 beds), one month
For just 8 simple treatments which are laxatives, or for pain relief
or a food supplement / additive this home sent back just
under £250 worth in one random month, for instance:
£55 of paracetamol 500mg tablets
£56 of complan shake
£67 of movicol/laxido sachets
All of this could have been carried forward to the next cycle.
Some solutions
• Bulk prescribing
• Reduction of quantities of ‘prn’ meds to
prevent re-packaging in MDS
• Working with the care home to help them
understand expiry dates, carrying medicines
forward into the next re-order cycle and only
ordering what is needed
Clinical review and clear directions
• Initiated after acute admission but not reviewed or
stopped e.g. Opioid pain relief
• Meds taken historically but no current indication
• No longer clinically appropriate due to change in
condition
• Only intended for a defined period of time
• Clear dosage schedule e.g. Pain relief
• Instructions to crush tablets for administration
Expensive formulations
May be a needless waste of NHS resources
e.g. Levothyroxine liquid 100mcg/5ml, patient
able to swallow tablets.
Changed to tabs, annual saving £1515
Cavilon film spray and cream – appropriate use?
Cavilon barrier cream £7.99 for 92g to conotrane 88p for 100g
Some more solutions
• Guidance produced for on
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Bulk prescribing
Standard dosage instructions for common medicines
Benzodiazepines and Z drugs
Pain relief for mild to moderate pain
• Pharmacies supplying care homes can help
reduce medicines waste and improve patient
safety.
Facts and figures
MAR review recommendations:
Approx. 70% of the recommendations result in a
change to prescribing this equates to:
Annualised savings c.£126k
Waste reduction through carry forward c£26k
Total £152k (2240 residents)
Thank you for listening
Bulk prescribing
For patients in an institution where the following requirements
are met:
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More than 20 residents
One GP practice looks after more than 10 residents
The item is prescribed for more than 2 patients
The item is not POM
Paracetamol
Rx Paracetamol 500mg tab
2qds (prn)
In the care home this usually
means
9am: 2x 500mg
1pm: 2 x 500mg
5pm: 2 x 500mg
9pm: 2x 500mg
Consider
Is 4g a day every day safe in an
elderly patient?
What about if the patient weighs
less than 50kg?
If they have all 4 doses over a 12
hour period what can be done
if they wake in the night in
pain
Older people excrete drugs more
slowly – 6hrly interval should
give continual pain relief if
needed.