41CARE HOMES LEARNING TOGETHER INITIATIVE: A COLLABORATIVE APPROACH TO CARE HOME MEDICINE

Abstract

Aims: Identify residents with challenging Medical and/or Psychological problems in Residential Care and apply Principles of Comprehensive Geriatric Assessment; and compare this structured approach to best practice guidelines (Enhanced Health in Care homes - NHS England) and combine with education sessions to enhance multi-professional learning. Methods: A multi-professional team was led by Primary care physician and supported by Primary Care Pharmacist, GP trainee and Specialist Registrars in Geriatric Medicine and Adult mental health services, and care home staff. · Care home staff identified patients for review and family invited to attend consultation. · Clinical information sought through primary and secondary care databases including Dispensing information through the patients Summary Care Record (SCR) · Two patients reviewed per 3 hour session · Pre-evaluation discussion with MDT followed by clinical assessment · Re-convene for discussion of proposed management plan · Complete educational topic and set new for following session · Compare with key domains in guidelines Results: · Five sessions attended in two care homes. · Seven patients assessed to date, one requiring acute admission. · Patient demographics: o 4 male, 3 female o Average (Mean) age: 81 years old. · Average (Mean) no. of comorbidities: 7 · 6 out of 7 had confirmed dementia (7th too unwell for further classification) · 5 educational sessions · Advanced care plans discussed in each case with patient and family (where available) with Advanced care plans now coded as "significant problem" in GP data-base · 7 DNACPR forms completed · Medication review in all resident with amendments made - overall reduced tablet burden · 5 out of 7 patients had a plan to change psychotropic medication · Positive feedback obtained from all clinical participants Conclusions: (1) Multi-disciplinary team working practical, enjoyable and with educational value (2) Care home residents are a complex, frail and elderly population with high degree of social isolation with limited family engagement (3) Physical and mental health assessment (including dementia) can be performed and activity can be applied to many of the domains set out in NHS England's "Enhanced Health in Care homes" model. (4) Medications review helped to reduce inappropriate medication use (5) Discussion improved confidence and language around Advanced care planning (6) Telephone consultation to family proved useful (7) Shared communication via IT solutions have limitations (especially Advanced care planning) but novel work-arounds can be found.