Nobody ever questions—Polypharmacy in care homes: A mixed methods evaluation of a multidisciplinary medicines optimisation initiative

Background Nurse-led monitoring of patients for signs and symptoms associated with documented ‘undesirable effects’ medicines has potential to prevent avoidable harm, optimise prescribing. Intervention The Adverse Drug Reaction Profile polypharmacy (ADRe-p) identifies documents putative adverse effects commonly prescribed in primary care. Nurses address some problems, before passing ADRe-p pharmacists prescribers review, conjunction prescriptions. Objectives We investigated changes in: the number nature residents’ problems as recorded on ADRe-p; prescription regimens; optimisation: healthcare costs. explored aetiologies identified stakeholders’ perspectives. Setting participants In three UK care homes, 19 residents completed study, December 2018 May 2019. Two service users, pharmacists, six nurses gave interviews. Methods This mixed-method process evaluation integrated data from ADRe-ps charts, at study’s start 5–10 weeks later. Results recruited 27 homes approached 26 45 eligible residents; least twice. Clinical gains were 17/19 (mean 3 SD 1.67, range 0–7). Examples included management of: pain (six residents), seizures (three), dyspnoea (one), diarrhoea (laxatives reduced, two), falls (two five able stand). One or more medicine was de-prescribed dose reduced 12/19 residents. ADRe administration review cost ~£30 staff time. helped carers bring attention prescribers. Implications relieved unnecessary suffering. It supported by providing a tool engage prescribers, only observable strategy multidisciplinary team working around optimisation. improved by: a) regular systematic checks problem documentation; b) information transfer home pharmacists; c) recording changes. Registration NLM Identifier NCT03955133 ; ClinicalTrials.gov.