Medicines Optimisation in Social Care and Care Homes
Why Focus on Care Homes and Older People? / 為什麼關注養老院和老年人？
Intrigue of complex patients with multiple medicines and learning opportunities. / 具有多種藥物和學習機會的複雜患者的陰謀。
Passion for improving patient outcomes and making a difference. / 熱衷於改善患者治療效果並有所作為。
Job satisfaction. / 工作滿意度。
Flexible working hours. / 靈活的工作時間。
Desire to learn about the aging process. / 渴望瞭解衰老過程。
Recognition that everyone ages. / 認識到每個人都會衰老。
Key Aspects / 關鍵方面
Emphasis on safety, governance, professional collaboration, and patient engagement. / 強調安全、治理、專業協作和患者參與。
Medicines optimisation is a key focus of the NHS. / 藥物優化是 NHS 的一個重點。
Definition of medicines optimisation (UKMI, 2012): An approach that seeks to maximise the beneficial clinical outcomes for patients from medicines. / 藥物優化的定義 （UKMI， 2012）：一種旨在最大限度地提高藥物對患者有益臨床結果的方法。
Medicines Optimisation in Care Homes (MOCH) / 護理院的藥物優化 （MOCH）
Optimising effectiveness and quality of medicines. / 優化藥物的有效性和品質。
Maximising safety in medication use. / 最大限度地提高藥物使用的安全性。
Maximising efficiency and value in medicines use. / 最大限度地提高藥物使用的效率和價值。
Working in partnership with: / 合作單位：
Patients / 病人
Care homes / 護理院
GP practices / 全科醫生實踐
Community pharmacies / 社區藥房
Local acute and community providers / 當地急症和社區提供者
Councils / 議會
CQC (Care Quality Commission) / CQC（護理質量委員會）
ICS (Integrated Care System) / ICS（綜合護理系統）
PCNs (Primary Care Networks) / PCN（初級保健網路）
Care Homes / 護理院
Nursing homes / 療養院
Residential homes / 住宅
Learning Disability Homes (residential homes) / 學習障礙之家（住宅）
Frimley ICS MOSCCH Team / Frimley ICS MOSCCH 團隊
Covers 145+ care homes with 5000+ residents. / 覆蓋 145+ 養老院，擁有 5000+ 居民。
Team consists of 3 Pharmacists and 2 Pharmacy Technicians. / 團隊由3名藥劑師和2名藥房技術員組成。
Aims: / 目標：
Person-centered care. / 以人為本的護理。
Better-integrated care. / 更好的綜合護理。
Improve the quality of care and patient outcomes. / 提高護理品質和患者預後。
Reduce avoidable hospital admissions. / 減少可避免的住院。
Improve Patient Safety & Medicines Safety. / 提高患者安全和藥品安全。
Optimal medicines management and waste avoidance. / 優化藥物管理和避免浪費。
Quality Improvement. / 品質改進。
Serves as system leaders in medicines optimisation in care homes. / 在護理院的藥物優化方面擔任系統領導者。
What's Involved in Medicines Management and Optimisation? / 藥物管理和優化涉及哪些內容？
Medicines Management / 藥品管理
CQC regulation. / CQC 法規。
NICE SC1, NMC, SCIE guidelines. / NICE SC1、NMC、SCIE 指南。
Review of care home policies, systems, and processes. / 審查護理院政策、系統和流程。
Audits. / 審計。
Medication incident reporting. / 藥物事件報告。
Medicines risk assessment and risk management. / 藥物風險評估和風險管理。
Expert advice and support to care home staff. / 為護理院工作人員提供專家建議和支援。
Safeguarding. / 維護。
Good Practice Guidance. / 良好實踐指南。
Training. / 訓練。
Joint working with commissioners and providers. / 與專員和提供者聯合合作。
Fostering a Medicines Safety Culture. / 培養藥品安全文化。
Medicines adherence support. / 藥物依從性支援。
Medicines waste avoidance. / 避免藥物浪費。
Infection outbreak support. / 感染爆發支援。
EMIS Proxy Rx ordering. / EMIS Proxy Rx 排序。
Medicines Optimisation / 藥物優化
Evidence-based prescribing. / 循證處方。
Optimising prescribing. / 優化處方。
'Deprescribing' / Polypharmacy management. / “Depreschiring” / 多藥管理。
Drug monitoring. / 藥物監測。
Addressing anti-psychotics use in dementia. / 解決失智症中的抗精神病藥物使用問題。
STOMP (Stopping Overmedication of People with a learning disability, autism or both) initiative. / STOMP（停止對有學習障礙、自閉症或兩者兼而有之的人過度用藥）倡議。
Liquid specials management. / 液體特價管理。
Hypnotics review. / 催眠藥評論。
Managing anti-cholinergic burden (ACB). / 管理抗膽鹼能負擔 （ACB）。
Nutrition and hydration support. / 營養和補水支援。
ONS/SIP feeds. / ONS/SIP 源。
GPs prescribing support. / 全科醫生開具支持處方。
Falls prevention strategies. / 跌倒預防策略。
Incontinence management. / 失禁管理。
Wound care. / 傷口護理。
Dysphagia management. / 吞咽困難管理。
Medicines safety measures. / 藥品安全措施。
Medicines related hospital admission avoidance. / 避免與藥物相關的住院。
End-of-life care. / 臨終關懷。
Infection outbreak treatment. / 感染暴發治療。
Collaboration and Integration / 協作和集成
Integration between secondary care (hospitals, specialists) and primary care (GPs, PCNs). / 二級保健（醫院、專科醫生）和初級保健（GP、PCN）之間的整合。
Collaboration with care associations, CQC, and local authorities. / 與護理協會、CQC 和地方當局合作。
Involvement of specialist community teams, including end-of-life care and community mental health teams. / 專業社區團隊的參與，包括臨終關懷和社區心理健康團隊。
Focus on digitalization in care homes using tools like NHS.mail, EMIS proxy, Connected Care, and Docobo. / 使用 NHS.mail、EMIS 代理、Connected Care 和 Docobo 等工具專注於護理院的數位化。
Partnerships with community pharmacies, LPCs, and infection prevention and control agencies. / 與社區藥房、LPC 和感染預防和控制機構建立合作夥伴關係。
Links with research institutions like the University of Reading for studies on antipsychotics, psychotropic drugs, medicines reuse, and the OSCAR study. / 與雷丁大學等研究機構建立聯繫，進行抗精神病藥、精神藥物、藥物再利用和 OSCAR 研究。
Engagement with ICS Quality Teams for projects on hydration, medicines safety, and polypharmacy. / 與ICS質量團隊合作，開展水合作用、藥物安全和多藥治療專案。
Quality Improvement Initiatives / 品質改進措施
Review of Antipsychotics in Dementia: Led to a 24% reduction in prescribing. / 失智症抗精神病藥物回顧：導致處方減少 24%。
Good Hydration in Care Homes Project: / 護理院的 Good Hydration 專案：
Collaborative work with Oxford AHSN and care homes. / 與牛津 AHSN 和護理院合作。
Resulted in a 66% reduction in UTI hospital admissions and a 58% reduction in UTIs requiring antibiotics. / 導致 UTI 住院人數減少 66%，需要抗生素的 UTI 減少 58%。
Received national recognition with multiple awards. / 獲得國家認可，獲得多個獎項。
Medicines Safety Culture in Care Homes: / 養老院的藥物安全文化：
Focus on improving medicines safety. / 專注於提高藥品安全性。
Improving medication error reporting. / 改進用藥錯誤報告。
Medication Errors: Where Do They Happen? / 用藥錯誤：它們發生在哪裡？
Infographic highlights the types and locations of medication errors. / 信息圖突出顯示了用藥錯誤的類型和位置。
Most common types of errors include omitted medicine/ingredient, wrong/unclear dose or strength, and wrong frequency. / 最常見的錯誤類型包括遺漏藥物/成分、錯誤/不清楚的劑量或強度以及錯誤的頻率。
Care homes have the highest error rates per patient, leading to a high overall number of errors. / 護理院每個患者的錯誤率最高，導致總錯誤數很高。
Prescribing errors are most likely to cause moderate harm. / 處方錯誤最有可能造成中度傷害。
Most administration errors occur in care homes. / 大多數管理錯誤發生在護理院。
Potential solutions include: / 可能的解決方案包括：
Electronic prescribing and medicines administration systems. / 電子處方和藥物管理系統。
Proven interventions like PINCER. / 經過驗證的干預措施，如 PINCER。
Improved information for patients to promote joint decision-making. / 為患者改進資訊以促進共同決策。
Patient-friendly packaging and labeling. / 對患者友好的包裝和標籤。
Improved shared care across different settings. / 改進了不同設置下的共用護理。
Adequate training in safe and effective medicines use. / 對安全有效藥物使用進行充分培訓。
Encouraging reporting of medication errors. / 鼓勵報告用藥錯誤。
Reducing inappropriate polypharmacy. / 減少不適當的多藥治療。
The World Health Organization aims to reduce severe avoidable medication-related harm globally by 50% by 2022. / 世界衛生組織的目標是到 2022 年將全球可避免的嚴重藥物相關傷害減少 50%。
An Ageing Population / 人口老齡化
Increased life expectancy: Fewer people die before the age of 65 compared to 75 years ago. / 預期壽命延長：與 75 年前相比，65 歲之前死亡的人數較少。
Population shift towards older ages due to longer lives and fewer children. / 由於壽命更長、孩子更少，人口轉向老年人。
Significant projected increase in the population aged 65+ in England between 2023 and 2043. / 預計 2023 年至 2043 年期間英格蘭 65+ 歲的人口將顯著增加。
Rapid rise in the population aged 85+, who are most likely to need health and care services. / 85+ 歲的人口迅速增加，他們最有可能需要健康和護理服務。
Ageing and Multimorbidity / 老齡化和共病
Multimorbidity: The presence of two or more long-term health conditions. / 共存：存在兩種或兩種以上的長期健康情況。
Increases with social deprivation and age. / 隨著社交剝奪和年齡的增長而增加。
Affects approximately 1/4 of the UK population and 2/3 of people aged 65 years or over. / 影響大約 1/4 的英國人口和 2/3 的 65 歲或以上人群。
Associated with increased risk of functional decline, poorer quality of life, greater use of healthcare services, and increased mortality. / 與功能下降風險增加、生活品質變差、醫療保健服務使用增加和死亡率增加有關。
Frailty - What is it? / 虛弱 - 它是什麼？
A clinically recognised state of increased vulnerability and susceptibility to adverse health outcomes (Rockwood & Howlett, 2018). / 臨床公認的脆弱性和對不良健康結果的易感性增加的狀態（Rockwood & Howlett，2018）。
Results from ageing associated with a decline in the body’s physical and psychological reserves and is an important determinant of health outcomes in older people such as falls, long-term care needs, disability and death (Fried et al, 2001). / 衰老的結果與身體的生理和心理儲備下降有關，是老年人健康結果的重要決定因素，例如跌倒、長期護理需求、殘疾和死亡（Fried 等人，2001 年）。
Frailty is seen in up to 50% of people over the age of 85 years (Clegg et al, 2013) and is not an inevitable part of ageing; it is a long term condition, similar to diabetes or Alzheimer’s disease (BGS Fit for Frailty, 2014). / 多達 50% 的 85 歲以上的人會出現虛弱（Clegg 等人，2013 年），並且不是衰老不可避免的一部分;這是一種長期疾病，類似於糖尿病或阿爾茨海默病（BGS Fit for Frailty，2014 年）。
A clinically recognised state of increased vulnerability and susceptibility to adverse health outcomes. Arises from decline in physical and psychological reserves with ageing and is a key determinant of adverse outcomes like falls, disability and death. / 臨床公認的易感性和對不良健康結果的易感性增加的狀態。由於衰老導致身體和心理儲備下降，是跌倒、殘疾和死亡等不良後果的關鍵決定因素。
Up to 50% of people over 85 are frail, but it's not inevitable; it's a long-term condition like diabetes. / 高達 50% 的 85 歲以上的人身體虛弱，但這並非不可避免;這是一種像糖尿病一樣的長期疾病。
Clinical Frailty Scale / 臨床虛弱量表
A tool to assess frailty levels, ranging from very fit to terminally ill. / 一種評估虛弱程度的工具，範圍從非常健康到身患絕症。
Categories: / 類別：
Very Fit: Robust, active, and energetic individuals who exercise regularly. / 非常健康： 強壯、活躍、精力充沛、經常鍛煉的人。
Well: No active disease symptoms but less fit than category 1. / 嗯：沒有活動性疾病癥狀，但不如第 1 類。
Managing Well: Medical problems are well controlled, but not regularly active. / 管理得當：醫療問題得到很好的控制，但並不經常活躍。
Vulnerable: Symptoms limit activities; common complaint of being / 易危：癥狀限制活動;常見的抱怨