There are several priority areas for medicines optimisation in care homes:

1. Reduce polypharmacy, non-adherence and avoidable adverse drug events

Successfully reducing polypharmacy in frail older people requires a good understanding of the patient, and the risks and benefits of taking drugs in the context of their overall care goals and experience.

Pharmacist-led medication reviews in CHN have been shown to reduce polypharmacy, adverse drug events and falls, and also save costs. Medicines use reviews (MURs) and the new medicine service (NMS) aim to establish a picture of how patients use their medicines in order to improve their knowledge and use of those medicines.

They are patient-centred interventions that employ concordant consultations, coaching and other strategies to engage with the patient to optimise medicines use. They should not be undertaken in isolation, but integrated into local care pathways with robust referral and communication processes. They can produce useful information and insights that complement medication reviews and assist with making prescribing decisions.

Patients should be recruited opportunistically by pharmacists and pharmacy technicians when a need is identified, and also proactively by setting up local systems to receive referrals from care home staff, hospitals, GPs, other practitioners and relatives. Some requirements in the service specification may create barriers for care home residents – for example, obtaining consent and needing to undertake them in the pharmacy or over the phone.