Pharmacists based within care homes make them safer for residents, research shows

Research by the University of Leicester has shown that basing pharmacies in care homes makes them safer for residents.

The Care Home Independent Pharmacist Prescriber Study (CHIPPS) led by the University alongside NHS Norfolk Waveney trialled onsite pharmacists in dozens of care homes across the UK.

Evidence from the study shows that onsite pharmacists reduce the risk of potential harm to care home residents from medicine.

According to the study, which has been published in the BMJ today (Tuesday, 14th February), care home residents are routinely prescribed an average of eight or more medicines.

Medicine use is considered to be one of the main areas of risk in care home settings by both the government and regulatory organisations.

One study cited in the BMJ paper, says that 70% of care home residents experienced drug errors daily.

The University of Leicester-led study says that there have been regular calls for interventions to help to improve the management of medicine in care homes.

CHIPPS conducted a randomised controlled trial including 49 care homes across England, Scotland and Northern Ireland.

The study also involved 25 care home trained pharmacist independent prescribers who were integrated into care homes to improve medicines management and safety.

Researchers have determined that the implementation of pharmacist independent prescribers in care homes is safe, well received by all stakeholders and reduces potential future harm from medicines.

According to the study, independent monitoring of pharmacist activities and review of unexpected resident deaths and hospitalisations found no safety concerns. 

Interviews with general practitioners, care home managers, carers and residents identified a high level of satisfaction with the service provided by the pharmacist independent prescribers.

Analysis of the primary outcome of falls did not show a significant reduction, potential future harm from medicines was significantly reduced.

University of Aberdeen, Queen’s University Belfast, University of East Anglia, University of Leeds and Norwich Clinical Trials have also contributed to the research.

Project leader, Professor of Health Services Research and Head of School of Healthcare, David Wright said: “I am delighted that the culmination of this six-year programme of work, undertaken by an incredible group of researchers, clinicians and patient representatives has produced this result. 

“The CHIPPS model of care was very well received by all stakeholders. We believe that this was because both our training and model of delivery focused on the integration of the pharmacist independent prescribers into the medical practice and care home teams.

“This approach was supported by our process evaluation, which found that the intervention appeared most effective when the pharmacists were embedded within their local general practice.

“Furthermore, our pharmacist-led intervention was reported by some GPs to reduce their workload as they no longer had to routinely review and authorise large numbers of repeat medicines and the pharmacist prescribers assumed some of their care home responsibilities.

“The results support expansion of the current pharmacist role in care homes, to include prescribing and frequent visits, as it reduces future harm from medicines and helps care homes to improve their management of medicines.”

Professor Richard Holland who co-led the project commented: “Whilst it was disappointing that we did not significantly reduce falls, our process evaluation provided a potential explanation for this. 

“Less than a quarter of pharmacist interventions were found to potentially reduce the likelihood of falls, with a small percentage increasing their likelihood.

“A significant reduction in potential future harm from medicines is, however, a predictor of future clinical benefit and with many medicines with central nervous system effects stopped within the trial we can see how this happened.” 

He went on to comment that: “Overall, this was a high-quality study which, through independent review of pharmacist care plans, hospitalisations and deaths, did not identify harm resulting from the pharmacist independent prescriber activities. 

“This addressed concerns raised by some medical colleagues and a Scottish Ethics Committee at the start of the project, when we presented this model of care to them. 

“Thus, this study provides important evidence for the development of models of care in care homes which we consider should include pharmacist independent prescribers.”