Transforming care for people who have a learning disability: Improving medication safety

Posted on 7th May, 2015

Devon Partnership NHS Trust was one of six organisations invited to work with the NHS Improving Quality Team to address concerns about the safe, appropriate and optimal use of medication prescribed for people with a learning disability. The Additional Support Team (South) have undertaken this project collaboratively with our Trust's Medicine Management Team over the last six months, with the aim of improving safety and positive outcomes for people where medication is an appropriate treatment option. The results have demonstrated an improvement in medicine reconciliation, leading to an increase in targeted pharmaceutical interventions, through the development and use of a pharmacy triage tool. Prior to the pilot 95% of people referred were taking medication, but medicine reconciliation was only completed for 9%. Without an accurate record of the medication someone is taking, and why, it was impossible to know whether the treatment was appropriate or beneficial. During the pilot, medication reviews by a pharmacist resulted in 33 interventions. Given the short duration of this pilot (six months), it is not possible to establish what the longer-term health outcomes of these interventions may be, but based on available evidence it is reasonable to assume that changes in practice (medication and/or monitoring) have contributed towards improving the overall health and wellbeing of the individuals in this service (through optimising treatment and preventing harm). A full report of the pilot project is available here, and this work will be presented to the Trust Learning Disability Governance Group in order to consider the continuation and/or spread of this initiative to other community learning disability teams. This initiative has demonstrated how collaborative multi-professional working can lead to improved care and patient safety, and firmly supports the delivery of professional guidance from the Royal College of Nursing on ‘Meeting the health needs of people with learning disabilities’ as well as joint professional standards ‘Working together to help patients make the most of medicines’ (RCN & RPS, 2015).  This work also reminds us about the importance of continuing to listen to and reflect on feedback from the people who use our services (and their supporters) in order to maintain and develop accessible information about medications in a form(s) that is tailored to their needs. Read more about this initiative here or contact a member of the project team - Dr Flo Watt, Consultant Psychiatrist, Amanda Gulbranson, Pharmacist, or Lee Cornish, Senior Nurse Practitioner and MMLP - by emailing