Pilot of a Charter to Improve Management of Medicines and Oral Care for Residents with Dysphagia in Care Homes.

Jacqueline Morris,Richard Griffith,Dharinee Hansjee,David Smithard,Rachel Power,Timothy Longmore,David Wright,Frances Hollwey,Eleanor Dann-Reed

doi:10.3390/geriatrics3040078

Abstract

Research in care homes has demonstrated that medication management practices in patients with dysphagia and those receiving medicines covertly may be inappropriate, illegal, and potentially cause harm. This paper presents the results of a feasibility study piloting a resident and healthcare professional best practice charter to improve such practices in care home residents with dysphagia. A charter was developed through a multi-professional expert panel, implemented in one care home, and then piloted in 22 homes in England, Wales, and Northern Ireland. A website was setup and developed iteratively to support the process. Care home staff and residents provided initial feedback on the implementation process and on perceived outcomes six months post implementation. A total of 16 (88.9%) out of 18 respondents from nine homes for six months reported a positive response to the charter. More than 80% of responses regarding the implementation process, impact on staff confidence, and perceived usefulness of the charter were positive. Perceived effectiveness and usefulness could, however, be further improved especially the perceived effect on frequency of medication review, which is reliant on external stakeholder involvement. The charter and supporting website were well received with respondents believing that it was useful, staff showing more confidence, and residents having enhanced care. Approaches to enhancing the charter’s effectiveness were identified.

Highlights

In 2011, there were 291,000 older people aged 65 and over living in care homes in the UK and, of these 164,000 people, were ones over 85 years of age [1]
The charter, which was informed by the national guidance on improving medicines management in care homes [33], was drafted by the expert panel with statements regarding the need for regular medication review to identify swallowing deficits, ensure that medicines are administered appropriately, ensure that the laws related to covert administration were adhered to, and all decisions should involve the resident or their representative
This paper describes the process undertaken to pilot and test the implementation of a charter to improve care for residents with swallowing problems in care homes

Summary

Introduction

In 2011, there were 291,000 older people aged 65 and over living in care homes in the UK and, of these 164,000 people, were ones over 85 years of age [1] They have complex needs including significant frailty, dementia, and disability [2]. Researchers in the UK have shown that care home residents are prescribed a mean of 7.2 medications and that seven out of 10 residents were found to have been exposed to at least one medication error [3]. These were not limited to drug, dose, and formulation selection and included dispensing, administration, and monitoring errors. Researchers using standardized criteria continue to identify high proportions of prescribed medicines in care homes as being potentially inappropriate [4]

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