Optimising medicine administration in care homes: opportunities for pharmacists?

Focal points: - This study aimed to identify difficulties experienced by nurses when administering medicines in care homes and strategies used to overcome them, using an ethnographic approach (observations). - It was observed that nurses spent a significant proportion of their day undertaking medicine administration, and difficulties that led to time inefficiencies e.g. residents refused to consume all or some medicines were overcome with strategies such as administering medicines covertly in food or drink. - The nature of observed medicine administration difficulties and strategies used to overcome them indicate that nurses could benefit from greater pharmaceutical input into medicine administration processes. Introduction: Community pharmacists in the UK play a central role in the medicine management of older persons living in care homes (CHs). CH staff use pharmacy-prepared medicine organisers or pharmacy-dispensed original medicine packaging to administer large volumes of medicines to residents. However, there is limited published research that has ethnographically explored howmedicine administration is conducted in CHs. Research of this nature could inform quality improvement of pharmacysupplied medicine services. This study aimed to identify difficulties experienced by nurses when administering medicines in CHs and strategies used to overcome them. Methods: This presentation reports on observations conducted as part of a larger, mixed methods study (conducted from October 2014 to March 2015). It involved a pharmacist researcher spending 3–4 days at five purposively sampled CHs in Greater London. The qualitative component involved observing nurses administer medicines during the breakfast, lunch and dinner medicine administration rounds (an ethnographic approach). The researcher aimed to observe 230 solid, oral medicine doses administered per CH (this determined the visit duration at each CH). University ethics committee approval was obtained. Results: 26 nurses were observed during 44 medicine administration rounds. It was observed that nurses spent a significant proportion of their day undertaking medicine administration. Often, medicine administration did not occur time efficiently because residents required lengthy periods of time to consume medicines, or they refused to consume all or some medicines. Nurses employed various strategies to overcome these difficulties including: repeatedly re-visiting the resident to retry administration; crushing medicines; administering medicines covertly in food or drink; and asking a staff carer to administer the medicine. Observed consequences of time inefficient medicine administration included minimal time gaps between administration rounds and non-adherence to administration instructions of time- or food-sensitive medicines. Discussion: The pharmacist researcher observed difficulties experienced by nurses when administering medicines, including lengthy periods of time for administration. Strategies nurses used to overcome these difficulties (e.g. crushing medicines and administration in food or drink) could benefit from an understanding of pharmaceutical principles. These findings will inform potential strategies to address observed medicine administration difficulties, for example: undertaking medicine reviews to identify opportunities for de-prescribing; using alternative formulations for prescribed medicines e.g. liquids, crushable forms or patches; regularly reviewing and communicating individual residents’ medicine administration preferences; ensuring widespread awareness of medicines with important time, food and crushing sensitivities; and undertaking education on how to administer medicines with food or drink to ensure they are consumed in their entirety and their pharmacological effects are not impaired. Pharmacists have a role in improving care in CHs.1 Future research could explore howpharmacists can support CH medicine administration processes, in terms of difficulties nurses experience and strategies to overcome them.