Transcript Southern Health and Social Care Trust Acute Care at Home

“If you can’t explain something simply, you don’t understand it well
enough” Attributed to Albert Einstein
Acute Care at Home Team
Southern Health and Social Care Trust
Des Gourley
Care of the Elderly Pharmacist
Why Acute Care at Home?
Fastest growing over
65 population in NI.
From 2012 to 2023 the
over 65 years
population is set to
grow by 36%, over 85
years by 73%.
Increasing pressure in
ED and Acute care
Increase in people
living with LTCs. The
SHSCT have specialist
COPD, Heart Failure,
Diabetes, Stroke
services in place
Transforming Your Care, A Review of Health and Social Care
in Northern Ireland, DoH 2011
“The Right Time, The Right Place”
Donaldson Report ,2014
“The emphasis should be on
why we do a job”
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What are pharmacists for?
– Medicines Optimisation!
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Aim to understand the patient's experience
Evidence based choice of medicines
Ensure medicines use is as safe as possible
Make medicines optimisation part of routine
practice
Clinical Pharmacy
Input
Multidisciplinary
Working
Independent
prescribing role
Ensure medicines use is
as safe as possible
Aim to understand the
patient's experience
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Medicine history taking
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Medicines
reconciliation
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Domiciliary medication
review
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Medication supply
Make medicines
optimisation part of routine
practice
Evidence based choice of
medicines
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Prescribe and amend on
kardexes.
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Amend dosages of preadmission prescribed
medications
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Prescribe for minor
ailments / MRSA
eradication / continuation
of treatment
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IV to oral switches of
antibiotics
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Prescribe for acute
medical treatment as per
plan
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VTE prophylaxis while
under care of AC@HT.
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Clinical checking of
prescriptions
Writing prescriptions
Dispensing urgent
supplies
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Daily MDT meeting.
Provision of Medicines
Information Advice
Point of contact for
community pharmacy
Extra complexity in terms
of governance and
medico-legal implications
Resource implications
What are the outcomes?
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518 referrals accepted in 2015-16
465 patients successfully treated at home
Improved care experience for patients and their families –
excellent feedback from users
Clinical pharmacy metrics
– Rates of medication reconciliation (54%)
– Number of domiciliary medication reviews (27%)
– Reduction in polypharmacy
– Reduction in anti-cholinergic burden (21%)
Anti-Cholinergic Burden
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Use of drugs with anticholinergic
effects associated with increased risk
of cognitive impairment, falls and allcause mortality in older adults.
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Use medication review to identify and
minimise use of drugs that may
adversely affect cognitive functioning
and to reduce their risk of falling.
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On average medication changes by
AC@HT reduced ACB by 21% for
2015-16
SHSCT Over 75yrs Non-Elective Admissions (17 GP Practices)
800
700
For GPs in the non pilot area who do not have access
to AC@HT over 75yr admissions rose from 525 to 609
admissions per month for the period from September
2013 to April 2014 compared to September 2014 to
April 2015. An increase of 16% year on year
AC@HT
start date
600
500
400
300
200
100
0
Average monthly admission for over 75yr patient for the
17 GP practices involved in the pilot area rose from 186 to
197 admissions per month for the period from September
2013 to April 2014 compared to September 2014 to April
2015. An increase of only 6% year on year
Pilot Area
Non Pilot
GPs
Non-Elective Nursing Home Admissions to SHSCT Acute Hospitals
Total SHSCT NH Admissions
70
65
58
56
56
55
52
51
50
12 month average from
September 2014 to August
2015 was 38 NH admissions
per month
50
48
47
48
46
46
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39
40
12 month average from
September 2013 to August
2014 was 49 NH admission
per month.
35
39
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35
31
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28
26
25
Aug-15
Jul-15
Jun-15
May-15
Apr-15
Mar-15
Feb-15
Jan-15
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
20
21
Sep-15
60
AC@HT started to
accept referrals for NH
patients in September
2014
63
“Fall seven times. Stand up eight.”
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Development of the pharmacy service to AC@HT
– Division of workload
– Improve follow up
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Better use of IT and electronic systems
– Paris
– ECR
– Electronic prescribing
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Develop links with other pharmacists providing medicines
optimisation
– Case management pharmacists
– GP practice pharmacists