461 Developing a Carer-Led Intervention Supporting older people and their carers with Medicines Management through pathways of care using interviews: a qualitative service evaluation
Authors: Merchant E , Abdelaziz S , Franklin B D , Tetteh D , Garfield S 
Published: April 2023

Abstract

Introduction
Previous studies have shown that informal carers involved in assisting with patients’ medicines have considerable knowledge about patients’ usual medication management (1). This could be helpful for healthcare professionals (HCPs) in secondary care caring for such patients and facilitate their safe discharge. However, carer involvement is often lost during patients’ hospital admissions, as carers report feeling excluded from decisions surrounding patients’ medicines management (2).

Aim
To assess the opinions of HCPs, patients and carers on strategies in place for HCPs to (i) identify informal carers during patients’ hospital admissions and (ii) aid communication between HCPs and carers with regards to medicines management during an inpatient stay and after discharge.

Methods
Semi-structured interviews were conducted with HCPs (doctors, nurses, pharmacists, occupational therapist and physiotherapist), adult patients, and their unpaid carers assisting with medication at home. Participants were recruited from three elderly care wards at one London teaching hospital. HCPs were approached directly; patients and carers were recruited with assistance from ward HCPs. Interviews explored participants’ opinions on current and potential methods for HCPs to identify informal carers, as well as how communication between HCPs and carers about medicines management could be improved. Interviews were transcribed verbatim and analysed using thematic analysis.

Results
Sixteen interviews were conducted. Thirteen participants provided demographic data, eight identified as female and five as male. Six identified as white British, one as Indian and one as Asian. A number of barriers to effective identification of carers were identified. Some HCP and carer participants were unaware of the carer’s identification lanyard provided by the hospital, which could help identify patients’ informal carers. Carers and HCPs suggested information about who assisted with medicines was not always passed between different HCPs, and that this should be on a central record that is assessed by all HCPs.
Carers expressed the need to be kept updated on changes to medicines throughout the patient’s stay. Carers and HCPs made suggestions to improve this, including having a central point of contact to update carers during a patient’s hospital admission, having ‘five minute update’ discussions throughout admission, and involving carers in multidisciplinary interactions. Finally, carers suggested having access to written information about medication changes, especially before discharge. Carers and HCPs also identified lack of post-discharge follow up communication. Some HCPs and carers proposed community teams lead on follow-up, but HCPs highlighted the need for a clear referral process between secondary and primary care. Other carers and HCPs suggested the HCP teams looking after the patient during admission should follow-up with patient and carer shortly after discharge.

Conclusion
A strength of this service evaluation was identification of possible solutions to the problems identified. By asking about the personal experience of patients and carers, we identified suggestions for improvement. The main limitation is potential lack of generalisability, as interviews were only conducted at one hospital. The findings will be used to inform the development of a tool to improve communication and carer involvement in the medicines management process during an inpatient admission and after discharge.

References
1. Alhaddad B, Taylor KMG, Robertson R, Watman G, Smith FJ (2015) Assistance provided by family carers for COPD patients using nebulisers at home. European Journal of Hospital Pharmacy. doi:10.1136/ejhpharm-2015-000735.
2. Garfield S, Jheeta S, Husson F et al (2016). The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study. PLOS ONE. http://dx.doi.org/10.1371/journal.pone.0153721.