Medication review for those with polypharmacy receiving care at home and in care homes

The following recommendations were made for people receiving care at home and in care homes. People receiving care at home are potentially as frail as those living in a care home. When considering care homes and care at home services, there is the opportunity to undertake the reviews as part of an MDT.

Based on three guidelines^70,71,72 (one with mixed quality and two with lowest possible quality) and six SRs of high quality,^{54,73,74,75,76,77} the table below sets out the recommendations on reviewing the evidence, and a considered judgment process.

Medication review for those living in a care home or receiving care at home

1 - Conditional recommendation

Prescribers responsible for those living in care homes could utilise information from different sources, to identify those appropriate for review to reduce polypharmacy, e.g. the polypharmacy case finding indicators

2 - Good practice point

Relevant tools can be utilised to prioritise medication review, such as polypharmacy case finding indicators or criteria based on STOPP/START (Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment

3 - Good practice point

People in care homes should have a multidisciplinary medicines review on admission and then at least yearly, in particular for potentially inappropriate medications (PIMs) and antipsychotics

4 - Strong recommendation

Offer small group educational sessions to care home staff as this can lead to a decrease in prescribing of a range of medications, including antibiotics and neuroleptics

5 - Conditional recommendation

Care home staff and healthcare professionals (HCP) should be aware that certain medications can increase the risk of falls and harm caused by falls

6 - Conditional recommendation

Medication Sick Day Guidance should be discussed with care staff so harm can be prevented during an episode of acute dehydrating illness.

7 - Strong recommendation

Shared decision-making (part of 7-Steps process) reflecting the stated wishes of individuals and families or carers, to improve quality of care, is important as part of a medication review