By Liz Butterfield, Immedicare (www.immedicare.co.uk) Specialist Pharmacist
The COVID-19 pandemic continues to shine a spotlight on how we care for our elderly. The negative impact of the pandemic on care home residents has been immense, but there have also been glimmers of hope and opportunities to make positive transformations that improve integrated care now, and into the future.
Nearly one year ago, NHS England asked primary care providers to increase their support for care homes.1 An important element of this was integrating a pharmacist into the care pathway and providing pharmacy and medication support such as structured medication reviews via telephone or video, supporting reviews of new residents or those recently discharged from hospital, and supporting care homes with medicines queries.
Recent data suggests that some medications and combinations of treatments can contribute to an elderly person’s risk of falling.2-4 It is also well known that falls are the leading cause of emergency hospital admissions for older people5,6 and the most frequent reason for calling the telehealth clinical assessors for support and advice.7 During the pandemic, there was a clear and urgent need to protect care home residents from hospitalisation and the risk of hospital-related complications and infections, including COVID-19.
To address the combination of these factors, Immedicare*, a clinical and technology partnership between Involve Visual Collaboration Ltd and Airedale NHS Foundation Trust (ANHSFT), took action. The idea was to undertake a pilot in the Bradford District and Craven area to reduce the risk of falls recurring in elderly care home residents through proactive medication reviews, and by doing so, reduce the negative impact falls have on the resident and local health services, such as hospitalisation.
This was an area where I thought the expertise of a pharmacist, combined with the innovative technology of a telehealth service, could have a real impact. As a passionate advocate for the critical role pharmacists play in integrated care systems across the NHS, and with my experience in medicines optimisation for older people, I was keen to be involved in the pilot.
When a resident falls in one of the 690 UK care homes where the telehealth service is in place, they receive an immediate virtual clinical assessment from a highly skilled, multidisciplinary team of specialist nurses based at ANHSFT. They determine whether the resident stays in their place of care or needs to be dmitted to hospital.
Before the pilot was introduced, there was a significant unmet need in Bradford District and Craven. From 125 care homes in the area where the service was in place, there were 1,420 calls between March 2020 and February 2021 relating to falls. Following a virtual assessment, 89.3% stayed in their place of care without onward referral.7 While it is hugely beneficial for residents to receive expert clinical care in their home, there is a risk their medications are left unassessed, and a future fall may occur again and result in greater harm.2-4
This is where my unique role in the pilot comes in as it is my job to assess residents that remain in their place of care following a fall and identify those that are at a high risk of falling again. I then work directly with local GPs and care home pharmacists to optimise their medication and reduce their risk of a second, potentially more damaging, fall.
The potential value of this approach is huge. Reviewing medications that are known to increase the risk of falls, and therefore reducing a person’s risk of falling, has significant benefits for the resident and local healthcare system. For the resident, it means protecting them from a stressful, disorienting hospital visit and reducing the risk of hospital-related complications and infections, such as COVID-19. For the local health system, it means reducing ambulance conveyances and emergency admissions. The approach is also fantastic for local care home and pharmacy communities, as it seeks to change the way care homes respond to their residents’ falls and ensure that a pharmacist’s input is a key component of the clinical assessment and rehabilitation plan.
While the pilot is still in its infancy, early feedback from care homes, GPs and pharmacists in the Bradford region has been extremely positive and impact data is currently being collected on medication reviews and treatment adjustments following a fall.
*Immedicare is a secure, video-enabled, clinical healthcare service linking care homes to the NHS with 24- hour access to a highly skilled, multidisciplinary clinical team based at Airedale NHS Foundation Trust. The service has been adopted by 690 UK care homes to date.
1. https://www.england.nhs.uk/wp-content/uploads/2020/03/the-framework-for-enhanced-health-in-care-homes-v2-0.pdf (Last accessed May 2021]
2. https://www.rcplondon.ac.uk/file/933/download [Last accessed May 2021]
3. https://www.bgs.org.uk/resources/12-cga-in-primary-care-settings-patients-at-risk-of-falls-and-fractures [Last accessed May 2021] 4. Freeland KN, Thompson AN et al. Medication Use and Associated Risk of Falling in a Geriatric Outpatient Population. The Annals of Pharmacotherapy 2012; 46 (9):1188-1192
5. https://www.nhs.uk/Scorecard/Pages/IndicatorFacts.aspx?MetricId=8135 [Last accessed May 2021]
6. https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health [Last accessed May 2021] 7. Data on Immedicare file.