Caring for patients at home

Nisha DesaiBy Nisha Desai, Senior  Clinical Pharmacist for Frail Elderly Services, Northumbria NHS Trust

Our ageing population presents huge challenges when managing medication. Around 36% of people over 75 take four or more prescribed medicines and up to 50% of medicines prescribed for older people are not taken as intended. The good news is that pharmacists can make a huge impact with this group of patients.

At Northumbria Healthcare NHS Foundation Trust, we have developed a domiciliary pharmacy service as part of the Local Integrated Network which aims to join up care programmes across health and social care systems.

How does it work?  

Vulnerable, frail elderly patients taking multiple medicines are visited in their own home to help them take their medicines correctly and reduce unplanned hospital admissions. Local GP’s, community matrons, social workers, pharmacists and even secondary care physicians all work together to achieve this. We have developed a much more cohesive way of working, with patients at the centre of the service and barriers between primary and secondary care significantly reduced.

I am the domiciliary pharmacist for Northumberland and North Tyneside. To date we have received almost 100 referrals from just 16 practices, indicating the level of need.

How did we get started?

Initially, we liaised with all the GP practices in the area to explain the service. Some were very keen from the start, others less so, probably due to lack of knowledge of the potential benefits. . Many of these concerns have now eased through various strategies including word of mouth and GPs realising how our service benefits patients and improves efficiency all around for the NHS. Getting access to patient records and learning how to use them was another barrier, but this was essential in order to undertake a comprehensive medication review.

Having a background in hospital pharmacy, domiciliary visits were completely new to me. It was daunting to know I was going to be working alone and entering a patient’s home, but it is now something I relish. Involving the patient and carers/relatives in their own environment is very valuable as it allows us to gain a greater insight into potential problems. I ask patients what they think as it important for the patient to have a voice and be involved in their review. Being in their home enables me to see how they currently manage their medicines. Although this can often be alarming, some issues can be tackled there and then. It is not uncommon to leave a home with several bags of waste medicines.

Patient benefits

My approach to medicines has changed. Now, every medicine I see is scrutinised for current need. Heavy workloads often prevent us from spending valuable time with patients, but this is the luxury of domiciliary visits and something that is greatly appreciated by the elderly. Often, just caring, having the time to listen to their problems and explain important information can make the difference between their taking a medication correctly and may be the ultimate difference which prevents an unnecessary emergency admission.

Knowing the patient has benefitted from our service is very satisfying, as is hearing GP’s and community matrons praise our input. One of the most rewarding aspects has been building relationships between pharmacists and GPs. My position, based in hospital but working in GP practices, allows me to be central to this integrated way of working which makes patient-centred care a reality.

To see the service I provide watch this video.