Theme 2: ‘The resident is cared for’—shared goals in medicine management
’
ADVERSE EFFECTS, SECONDARY
GPs and PIPs highlighted a strength of having a PIP as ‘the linchpin in medicine management’ in that they had detailed pharmaceutical knowledge allowing them to take actions which would directly and specifically benefit residents. PIPs reviewed prescriptions and could actively seek to rectify any prescribing errors and reduce the drug burden related to adverse effects from medicines. By doing this, they importantly improved safety for the resident and helped to make MAR (Medication Administration Record) sheets fit for purpose thereby potentially reducing the risk of administration error. Changes PIPs could make ranged from small actions such as changing the time of eye drop administration, so residents were not woken every night by staff, changing tablet preparations to soluble form, to complex titrating of medicines, for example, reducing doses of morphine-based painkillers and stopping antipsychotic medicines. PIPs reviewed all medicines in the context of a resident’s current biomedical markers and stage of life.Residents, alongside some members of the multidisciplinary team, were sometimes uncertain of the PIP’s credentials, and PIPs reported that a few residents were reluctant to have their medicines reviewed, preferring to remain with prescriptions given by the GP or secondary care team. There were a few triads where CH teams struggled to recall changes which had impacted on residents’ well-being. These proved to be either homes where PIPs struggled to build working relationships and therefore their medication activity was negligible, or homes that already had highly developed relationships with either the PIP allocated to the intervention or with another pharmacist. In this latter case it was reported that most residents already received regular medication reviews.