Intervention
See supplementary materials for the CHIPPS protocol and the service specification (appendix 2 in the protocol).The PIPs visited the care homes to do medication reviews and optimise therapy for all participating residents, and they created pharmaceutical care plans to record their activity and provide a plan for future activity. Pharmaceutical care plans also allowed the PIP’s actions/plans to be recorded for the care home and the resident’s general practitioner. Additionally, the PIPs provided general support for improving care home processes for ordering medicines (to minimise opportunity for missed doses), administration of medicines (to reduce administration errors), medicines reconciliation when residents transferred between settings (to minimise opportunity for transcription errors), and staff training (to optimise requests for new medicines such as antipsychotics, laxatives, and analgesics). The nature and extent of delivery of each element of the intervention was individualised for the care home by the PIPs, each of whom was allocated four hours a week to manage an average of 20 residents over six months.PIPs were responsible for updating residents’ records within care homes and general practices and for communicating changes to the supplying pharmacist. They decided on the most appropriate methods for communicating changes to general practices and care homes—that is, orally, in writing, or in person, depending on the activity. The intervention was tailored to context (for example, training to care home staff) and was delivered according to need.