There are different types of medication reviews for residents. Community pharmacies can offer medicines use reviews (MURs), which are conducted with the resident but without access to their full patient notes. 

An MUR helps to establish a picture of how patients use their medicines in order to improve their knowledge and use of those medicines. They can also help pharmacy and care home staff start to tackle some of the common medicines-related issues in care homes, including:

• Falls. The risk of falls is increased in residents taking many medicines. Medicines that can increase the risk of falls include antihypertensives, anticholinergics and opioids
• Interactions. Common interactions include antiplatelet and anticoagulant, levothyroxine and iron or calcium preparations taken at the same time
• Indication. Medicines are often continued when they are no longer indicated. Many residents in care homes have been on their medicines for years and information as to why they were started can be lacking. As the health of a resident changes and perhaps they become more frail, the appropriateness of the medicine and its anticipated benefit may no longer outweigh the risks
• Anticholinergic burden. Many medicines have anticholinergic effects, and if several are being taken then the likelihood of adverse cognitive effects may increase. These can vary from person to person and depending on the medicine, but include blurred vision, dizziness, memory loss that can result in falls and accidents ending in hospitalisation. Studies have also shown an increase in mortality. If any of these issues are a concern, you can recommend that the resident has an MUR. Only then can stopping, changing or adjusting medicines to reduce the risk of these issues be considered.

Practice points

• What arrangements do you have locally to ensure that prescriptions are checked by the care home before the pharmacy dispenses the medicines?
• What procedures for correct and safe storage of medicines are currently in place at your local care home? Consider whether any improvements can be made
• What steps can be taken to help reduce medicines waste in your local care home?