Option 5 - Role of a medicines adherence pharmacist: Polypharmacy medication review in care homes

Theme 2 asks: Polypharmacy – Good Or Bad?

Jean Patterson describes her role as a medicines adherence pharmacist before Ruth Campbell gives an Independent Prescriber’s experience of person-centred polypharmacy medication review within the Care Homes setting.

Jean Patterson, Specialist Case Management Pharmacist – Adherence and Support, Ulster Hospital, South Eastern Health and Social Care Trust, Northern Ireland 

Jean Patterson has worked in South Eastern Health and Social Care Trust for 12 years. She recently started in a new post as one of the Specialist Case Management Pharmacists - Adherence and Support based in each of the five Trusts in Northern Ireland (NI). The established role for a specialist Medicines Adherence Pharmacist evolved from an earlier research project and the NI Medicines Optimisation Quality Framework Document (2016) which identified, as one of the quality standards, the need to help people ‘remain independent and self-manage their medicines where possible but receive support with adherence when needed’. The specialist Medicines Adherence and Support Service has been established as one of the work streams of the Medicines Optimisation for Older People (MOOP) Pharmacy Team in each Trust.

‘Role of a medicines adherence pharmacist’

Medicines adherence assessment is an essential component of safe and effective patient care in the knowledge that up to 50% of patients on 4 or more medicines do not take them as prescribed. In Northern Ireland (NI) a specialist pharmacist-led service was established in the five Trusts to improve outcomes from prescribed medicines by ensuring safety and quality in the provision of adherence support for older people living in their own homes. Referrals are received from any Trust staff and an in-depth adherence assessment conducted in the patient’s home involving clinical review, access to medicines, day-to-day management and patient attitude. The clinical interventions and suggested solutions are implemented, often in partnership with primary care services, and followed up by the adherence pharmacist. The individualised care pathways support patients having medicine adherence issues to optimise medicine-taking and enables them to remain in their own homes.

Ruth Campbell’s background is in community pharmacy, where she has worked for Boots Pharmacy since 2000. Qualifying as a prescriber in 2006, Ruth developed her first clinic and established her own pharmacist-led chronic disease clinic for Atrial Fibrillation patients, for which she won the UK Pharma award of Community Pharmacist of the Year in 2007 and the Scottish Chemist Review award for Pharmaceutical Care the same year. Ruth has since broadened her Independent Prescribing experience, extending to other additional clinical areas including contraception, polypharmacy review for Care Home patients, Unscheduled Care. She has also established a clinic for unpaid carers. Ruth continues to practice in community pharmacy in addition to the above prescribing work and now also works in primary care pharmacy as one of two NHS Lanarkshire Medicines Management Pharmacists for Care at Home, a role held for over 5 years.

‘An Independent Prescriber’s experience - person-centred polypharmacy medication review within the Care Homes setting’

With over 6 years’ experience of polypharmacy medication review within the Care Homes setting, Ruth is a community pharmacist currently working with two Care Homes in Hamilton, Lanarkshire to provide Pharmacist Independent Prescriber polypharmacy review clinics for their residents. Care Home patients are represented in one of the commitments of the Scottish Government’s 2017 publication ‘Achieving Excellence in Pharmaceutical Care’. In addition, the 2018 Polypharmacy Guidance ‘Realistic Prescribing’ highlights this patient group within its criteria to prioritise patients for polypharmacy review. With frailty, high risk medicines and end of life care as common themes, Ruth uses the 7 steps medication review model to achieve appropriate polypharmacy during the annual medication reviews she undertakes for her Care Homes patients. Working with GPs, nurses, carers, families, CPNs and others, Ruth implements and communicates her prescription changes to support timely interventions, improving pharmaceutical care of this patient population.