Nationally, medicines waste has been estimated at £300 million each year, of which £50 million involved the disposal of unused medicines by care homes.
MLCSU Medicines Management and Optimisation (MMO) team developed a pilot project in conjunction with Birmingham South Central CCG. We reviewed how three care homes ordered and managed medicines over three months, to identify and reduce medicines waste.
Each care home selected for the pilot offered different care ranging from residential, stroke rehabilitation, nursing and dementia. Following agreement with the homes and organisations involved, the MLCSU pharmacy technician reviewed the medicines ordering processes including the exchanges between the care home, GP practice(s) and pharmacy.
The technician also reviewed policies, and staff knowledge about medicines order requirements. Training provided to six staff across two homes was then cascaded to up to 20 staff members. In addition, the technician helped develop and implement a policy for administering medication on a ‘when required’ basis in one care home.
The pilot was conducted over three months with a pharmacy technician working on average one day per week to produce an overall potential cost saving of £51.75 per patient.
The following table summarises the results in the three care homes:
|Description||Home A||Home B||Home C|
|Number of patients||53||73||23|
|Technician time||28.31 hours||8.32 hours||46.62 hours|
|Average annualised saving on avoidable waste*||£829.01||£843.31||£1984.36|
|Annualised saving on items not requested but prescribed||£1436.01||N/A||£599.30|
|Annualised saving on Education on expiry dates||£806.00||N/A||£171.00|
|Annualised saving on pack size calculation||£925.00||N/A||N/A|
|Annualised saving on homely remedies||£117.57||N/A||N/A|
|Annualised total saving||£4113.99||£843.31||£2754.66|
|Annualised total saving per patient||£77.62||£11.55||£119.77|
*methodology used to calculate the average was to annualise each 28 day monthly cycle and average this by the three month project length
Note that these figures do not take into account improved costs or time for education and training. The cost benefit of improved patient safety and any hospital admission avoidance is also not included.
As well as direct cost improvement from reduced medicines waste, a number of additional benefits were identified:
Whilst all care homes achieved some benefit, it was interesting to note that the pilot showed that the benefits varied for different care homes. A screening tool is currently in development by the MMO team to identify those homes that would benefit the most from this type of service.
Testimonial from Ruth Abbs, Clinical Lead, Andrew Cohen House:
“The support has been invaluable to us especially to our newer members of the nursing team. Giving them the support and understanding the processes of safe medication management has enabled us to improve our standards using best practice guidance. Liaison and support with the GP practice has been very helpful in order for us to update the Homely Remedies Protocol. The guidance given on managing stock and expiry dates has improved stock levels of medication within the home. The nurses said that having someone working alongside them and being involved in the processes was a very useful learning experience. They also felt reassured by having someone who is so knowledgeable in all aspects of the system.”