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New report on medicines safety in care homes

20 March 2020
Mistakes in medicines are a common problem in care homes, with one study suggesting as many as 70% of residents have experienced an error at some point.

The newly-launched ‘Medicine Safety in Care Homes National Report’ concludes that care homes have not had the benefits of the improvements made in medicines safety by the NHS and that the difference between care and health sectors must be addressed.

The work was conducted by Patient Safety Collaboratives across England (part of the AHSN Network), seeking to understand the reasons for medication errors and how these could be avoided in the future. The report concludes that care homes would benefit from support from Patient Safety Collaboratives who are well placed to foster a safety culture because of their extensive knowledge of quality improvement methods.

UCLPartners contributed to the fact-finding work by conducting interviews, attending forums, conducting visits to care homes, circulating a survey and hosting a Promising Practices event for those involved in the safe administration of medicines in care homes – including care home leads across the STPs, CCG pharmacists, Medicines Optimisation in Care Home (MOCH) pharmacists, clinicians working in care homes and care home managers and staff.   Conversations focused on understanding how the problems occurred and how they can be avoided in the future. Key areas of focus highlighted in the final national report, and supported by the UCLPartners research, included communication between care home, prescriber and dispensing pharmacy; care home staff training; leadership for safety; and the need to create a safety culture.

UCLPartners is one of 15 Patient Safety Collaboratives whose work informed this report.

One of the report’s leads, Tony Jamieson, Director of Transformation and Improvement at Yorkshire and Humber AHSN, who is a pharmacist by background, welcomed the opportunity the report offers pharmacists to help lead safety improvements in care homes.

Tony said: “As a profession we can rise to the challenge providing the help that care homes need. It will be important to learn from mistakes and employ innovations and digitisation wherever possible, but we need to remember that care homes are not small hospitals, but are places where people live.

“They are places that have to be run in an organised and safe way, so we have to remember any new way of doing things has to take that into account.”

Read the full report