Care Homes Independent Pharmacist Prescribing Study (CHIPPS). Feasibility Study early experiences
Prescribing in care homes is suboptimal with medication errors common. CHIPPS is a 5-year, NIHR-funded research programme, is to test the effectiveness of Pharmacist Independent Prescribers (PIPs) to improve medicines use and resident outcomes. Following development of the service specification with stakeholders, the model is being feasibility tested to inform a definitive randomised controlled trial.
Single arm feasibility study. One PIP and GP practices recruited at each site (Norfolk, Yorkshire, Grampian and Belfast). Inclusion criteria were that the practice cared for at least 15 care home residents. Following recruitment of care homes (1 in each of Norfolk, Yorkshire, Grampian and 3 in Belfast), 10 residents in each location were recruited and received the service from a trained PIP for three months Individualised pharmaceutical care plans (PCP) were developed for each resident to assist decision making and aid communication. Activity logs were reviewed at one month and PIPs undertook telephone interviews to obtain feedback.Ethical approval was received from East of England - Essex Research Ethics Committee and Scotland A REC.
Activities within the GP practice include: attending practice meetings, medicines reconciliation, care planning, repeat prescribing authorisation, monitoring, and referral to other healthcare professionals. PIPs report being made welcome at the care home, their expertise valued, as well as their direct access to the GP for resolving queries. At the care home, PIPs undertook: medicines reconciliation, provided general medicines management assistance (ordering/storage advice), shadowed medicines rounds, identified medicines-related issues e.g. inhaler technique, covert administration policies. PIPs provided 1:1 training, group training, met with residents and/or relatives to discuss general health, nutrition, mobility, continence, analgesia, antipsychotics and proposed medicine changes.Problems encountered included: difficulties meeting with groups of staff at homes due to service pressures, the PCP being time consuming to complete, and difficulty in one area arranging to meet the GP. The service was felt to be running smoothly where the PIP was already an established member of a GP practice team, but more challenging for one PIP assuming their new care home role alongside existing workload. At least one PIP (residents in 3 care homes) expressed concern that 16 hours/month is insufficient to manage these residents’ medicines.
Initial reports from PIPs confirm they are valued within the homes. Reported activities are as expected. Identified problems completing PCPs will enable us to revise study procedures for the definitive trial. Experience so far has confirmed the need for PIPs to be embedded within the GP practice.Evaluation of feasibility study findings will enable us to refine the service specification and recruitment scheme within the definitive RCT.