Background: Interactions to Reduce Acute Care Transfers (INTERACT II) study proved that early intervention of specialised outreach teams in the community prevents deterioration of residents and reduces hospital admissions. In addition to a reduction in hospital admissions, we wanted to review other interventions and outcome measures that an outreach service could provide. Project aims were to improve appropriateness of medications and residents' quality-of-life.
Innovation: In accordance with the Northern Trust review of the older people's pathway an outreach service was created to ensure nursing home residents remain healthy. Clinics are led by a Consultant Geriatrician and a Consultant Pharmacist with a member of nursing home staff. Four nursing homes have been completed so far. All residents care and medications are reviewed. There is liaison with the resident's general practitioner via letter. Medication review included the use of bisphosphonates and iron considering recent guidelines.
Evaluation: Polypharmacy causes a considerable burden on many residents. Medication review in one of the homes noted that 68% of patients were on over 10 medications. We identified common prescription cascades such as iron causing constipation requiring laxative therapy. In those without iron deficiency, iron was stopped in 22 residents in accordance with British Gastroenterology guidance. Review of bisphosphonate therapy, especially in immobile patients where bisphosphonates are contraindicated led to eight residents having this discontinued. Other medications classes which were reviewed included analgesics, non-steroidals, topical agents and food supplements.
Conclusion: Formal medication review and cessation of inappropriate medication is important in reducing medication burden and side effects, resulting in improved quality-of-life for residents. In the four nursing homes, 172 residents were reviewed. In total, we stopped 155 medications. Medication review has improved medication chart standards and increased efficiency for nursing staff. On-going access to the outreach service is supported by nursing home staff.