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Published on 25 January 2010

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A primary need to ensure optimal clinical pharmacy services for our old CHUMS

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Two landmark publications have presented pharmacists in England with a golden opportunity to demonstrate the value of clinical pharmacy services

Christine Clark
BSc MSc PhD FRPharmS FCPP(Hon)

Editor
HPE

Late in 2009, two publications identified major problems in the safe and effective use of medicines in elderly people. The first of these was a study that examined the prevalence and causes of medication errors in care homes for older people, and the second was a report concerned with the use of antipsychotic medication in people with dementia.

The first report, known as CHUMS (Care Homes Use of Medicines) showed that about two-thirds of care home residents were exposed to one or more errors during a short period.[1] Detailed interviews with staff identified a range of contributing factors, including inefficient ordering systems, inaccurate medicine records, and a high prevalence of verbal communication and medication administration systems that were difficult to fill and check. These problems were often compounded by factors such as lack of ready access to doctors, high workload, lack of medicines training and a “lack of teamwork between care homes, medical practices and pharmacies.”[1]

The authors suggested that what was needed was one person with overall responsibility for medicines use in each care home. They also pointed out that many pharmacists have the skills and knowledge to undertake this role. Such developments have been described in the UK government’s recent proposals for making best use of pharmacists expertise.

The second report described the extent of antipsychotic medicines use in dementia and the associated problems.[2] The author estimated that around 180,000 people with dementia are treated with antipsychotic medication across the country each year. Of these, up to 36,000 may derive some benefit from the treatment. The author also drew attention to the fact that there are substantial clinical risks associated with the use of these drugs, including a conservative estimate of 1,800 extra deaths and 820 extra serious adverse events such as stroke per year.[2]

Over the past 30 years, clinical pharmacy services have developed mainly in hospitals. Certainly there have been isolated examples of excellent services in primary care and other locations, but the main focus has been on hospital services. What these two reports underline very powerfully is that there are other places medicines are used where the need for good quality medicines management systems and advice can be critical. It may now be time for clinical pharmacists to direct their well-developed skills to these types of areas. There can be little doubt that this would be a great benefit to society, healthcare systems and the individuals concerned. So “if anyone is still looking for a worthwhile New Year resolution” here is the very thing.

References
1. Barber ND, Alldred DP, et al. Qual Saf Healthcare 2009;18:341-6.
2. Banerjee S. Department of Health Nov 09.



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