Introduction of a primary care formulary to a nursing home

Objectives/aims : Prescribing is the most common intervention General Practitioners do and accounts for the second highest area of HSE expenditure. Currently there is no Primary Care Prescribing Formulary in Ireland. As part of the HSE service plan 2016 there is a targeted 110 million reduction in prescribing and drug costs. Formularies improve quality of prescribing by decreasing the range of drugs used. The Medicines Management Programme has a single ‘preferred drug’ within a therapeutic drug class. These six medications are also recommended 1st line in the Glasgow Primary Care Prescribing Formulary. Method : The prescriptions for the 48 patients in Heather House nursing home were surveyed. The medications prescribed were compared to the Glasgow Primary Care formulary. A meeting was held between the pharmacist supplying the medications, the General Practitioners and the nursing staff of Heather House. Agreed changes were implemented in the following months prescriptions. Results : There was 118 total changes to medications made averaging at 2.5 changes per patient and 1.4 discontinuations over a 3 month period per patient (66 medications were discontinued). There was 18 benzodiazepine conversions to diazepam (with a 20% total reduction in benzodiazepine use).€30.15 per patient per month was saved leading to €361.83 per patient per year. Calculating the number of nursing home beds in Ireland this leads to a cost saving of 8 million per year. Conclusion : A formulary provides good evidence based prescribing that is both logical and provides value for money