Since the implementation of the Omnibus Reconciliation Act of 1987 in the USA, strict regulations and survey procedures have been developed to evaluate the care and services provided to residents in nursing homes¹. A standardised assessment tool is used by consultant pharmacists to regularly provide a comprehensive picture of each resident's functional, cognitive and emotional status. Part of this monthly or quarterly assessment is a drug regimen review, which focuses on the prescribing of psychotropic drugs (antipsychotics, anxiolytics, antidepressants and hypnotics) and diuretics. Extensive documentation is required for the prescription of psychotropic drugs.

This is in contrast to the UK where no standardised assessments of nursing/residential homes and their residents are in place. Legally the person in charge of the home, who is registered with the statutory body must make "adequate arrangements for the recording, safe-keeping, handling and disposal of drugs"². Contracted community pharmacists provide information on the safe storage, administration of medicines and appropriate record keeping within the home.

The aim of this study was to gain more detailed information on services currently provided by pharmacists to nursing/residential homes and to assess the opinions of those in charge of the care in these homes, on future services which could be provided by the pharmacist.

A postal survey was developed and sent to all nursing and residential homes (n=586) in Northern Ireland on two occasions. A response rate of 68% (n=396) was obtained.

The most frequent services currently provided by community pharmacists were the supply of medication and the collection of unwanted, discontinued or out-of-date medicines. The majority of respondents also reported receiving advice on safe-keeping and correct administration of medicines. Pharmacists also advised over 60% of the respondents on more appropriate formulations and over 50% of the homes received advice on patient medication records. Just over a third of the respondents (35%) received advice on compliance devices. A similar proportion (36%) stated that their care staff were trained by the pharmacist on broad medication management issues.

Over 90% of all homes strongly supported staff training by pharmacists on the recognition of medication-related problems as a future service. Over 70% of all homes thought additional guidelines and advice for missed dosages and the use of home remedies would be beneficial. A review of patient medication records to assess drug-drug interactions and possible adverse drug reactions by pharmacists was supported by over 75% of all respondents.

To the best of our knowledge this is the first survey of its kind in the UK. It demonstrated that those responsible for care in nursing/residential facilities are in favour of pharmacists expanding those services which will improve medicine management in vulnerable patients. The findings are being submitted to Health Boards in Northern Ireland, to inform the way in which future services in homes will be implemented.

References

1. ASCP. Regulatory Resource Series. Nursing Home Survey Procedures: Interpretative Guidelines 1995
2. HMSO. Registered Homes: The Nursing Homes Regulations (Northern Ireland) 1993