Centralized Collaborative Complex Care: Care Redesign Using the Triple Aim
Service Redesign Care Home Services
23
Service Redesign Care Home Services Paul Jerram Head of Medicines Management Isle of Wight CCG
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The Health & Care of Older People in Care Homes July 2000 A comprehensive interdisciplinary approach A report of a joint working party Royal College of Physicians Royal College of Nursing British Geriatric Society
Transcript of Service Redesign Care Home Services
Service RedesignCare Home
ServicesPaul Jerram
Head of Medicines ManagementIsle of Wight CCG
The Health & Care of Older People in Care HomesJuly 2000• A comprehensive interdisciplinary approach• A report of a joint working party• Royal College of Physicians• Royal College of Nursing• British Geriatric Society
Causes of Concern• Inappropriate usage of prescribed medication has
been demonstrated in care homes. SEVERAL STUDIES HAVE SHOWN THAT 20-25% OF CARE HOME RESIDENTS RECEIVE AT LEAST ONE INAPPROPRIATE PRESCRIPTION
• Millard et al found that only 25% of GPs in nursing homes regularly reviewed the medication of each resident.
Recommendation
• To introduce a specialist pharmacist for homes (and medication review of the elderly and specific high risk populations)
Analysis of Authorised Repeats for Medication & Dressings Before Review
Minor conditions54%
Dressings22%
Other drugs24%
Project •Following medication review, trained nurses, working to a protocol, can treat residents for minor conditions and use appropriate dressings without referral to a GP
Six Months Later• Improvement in prescribing against a number of
quality indicators• Improved medication regime for residents• Reduced workload for GPs, care home staff &
pharmacists• Reduction in cost of medication & dressings• Empowerment of nurse clinical team• Increased remuneration of pharmacists
Effect on Laxative usage26
21
1.10.2
3
0.5 0.9 0.5
0
5
10
15
20
25
30
Lactulose Senna Glycerin Supps Microlax
Aver
age
num
ber o
f dos
es g
iven
per
pat
ient
per
28
days
Before
After
Effect on Medication & Dressing Costs
4.433.65
11.23
19.31
1.52 1.21
8.21
10.94
0
5
10
15
20
25
Nurse managed OTC drugs Dressings Named patient drugs Total
Cos
t in
£s p
er p
atie
nt p
er 2
8 da
ys
BeforeAfter
Service Redesign• Brainstorm how we may improve existing services• Select most appropriate updates• Test concept and pilot• Evaluate• Roll out
Updates• Patient passport• Bar code patients• Remote access to medical records• E communication/records replaces paper• Increased patient safety via Radar/scheduled and
ad hoc monitoring• Proteus ingestible sensors for compliance check in
non care home patients• Carer or patient self monitoring
Patient passport
Patient Passport
Viewing other results
HELIUS PROJECT
HOME HYPERTENSION MONITORING PROJECT
The Isle of Wight is already introducing the innovative Patient Passport , a service that allows the healthcare team access to the patients health records safely, securely and efficiently.It allows access to the ‘essential aspects’ of patients medical records:
• Clinical Conditions
• Medications & Allergies
• Blood Results & Investigations
• Health Plans
