Medicines Optimisation

In response to COVID-19, we are supporting the wider deployment of Electronic Repeat Dispensing (eRD) across GP practices. This builds on work that has been going on locally to increase the utilisation of eRD across Kent, Surrey and Sussex.

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Medicines Optimisation -Helping patients get the maximum benefit from their medicines and reducing waste and harm.

The NHS spends £16.8 billion a year on medicines (£1 in every £7 that the NHS spends) and they are the most common treatment in the NHS.

Medicines help a lot of people get well but:

Medication safety continues to be a serious issue

Around 5-8% of hospital admissions are medicines related, many of which are preventable
Bacteria are becoming resistant to antibiotics through overuse which is a global issue
Up to 50% of patients don’t take their medicines as intended meaning their health is affected
Use of multiple medicines is increasing – over 1 million people take 8 or more medicines a day.

Our medicines optimisation projects:

Aim to understand the patients experience
Evidence based choices of medicines
Making medicine optimisation part of routine practice
Ensuring medicines use is as safe as possible.

Our programme of work is focusing on a number of key areas to improve support for patients to get the best from their medicines;

Community pharmacist support for patients leaving hospital
Preventing prescribing errors
Polypharmacy.

We work collaboratively with the other 14 health innovation networks to develop, share and spread good practice in medicines optimisation.

For more information

Contact kssahsn.medsops@nhs.net

TRANSFER OF CARE AROUND MEDICINEs

Community pharmacist support for patients leaving hospital

When some patients leave hospital, they can need extra support taking their prescribed medicines. This may be because their medicines have changed, or they need a bit of help taking their medicines safely and effectively. The transfer of care process between care settings is also associated with an increased risk of harm, with 30-70% of patients experiencing unintentional changes to their treatment, or an error being made because of a miscommunication. These are some of the challenges that the Transfer of Care Around Medicines Programme aims to address.

When patients are discharged from hospital, they may be referred through a safe and secure digital platform for advice from their local community pharmacist on how to manage their medicines with confidence. Improving the transfer of information about a patient’s medicines should also help to ensure that they continue to take the right medication on leaving hospital. Both aspects can reduce the incidence of avoidable harm.

Evidence has clearly shown that patients who saw their community pharmacist after their discharge from hospital were much less likely to be readmitted and, if they were, that they experienced a reduced length of stay. Further details on service evaluation can be found below.

The TCAM pathway also brings benefits to Community Pharmacy through improved workflow and operational processes, better informed dispensing and a reduction in waste medicine.

We are working with partners across Kent, Surrey and Sussex, including trusts, Local Pharmaceutical Committees and CCGs, to implement the pathway. Where possible we set up secure electronic interfaces between the hospital IT systems and community pharmacy systems in order to provide patient medicines information quickly and seamlessly between care settings.

This pathway is now live in East Sussex Healthcare NHS Trust, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Surrey & Borders Partnership NHS Foundation Trust, Royal Surrey NHS Foundation Trust, Medway NHS Foundation Trust, University Hospitals Sussex Trust and Darren Valley Hospital Trust.

There is a PharmOutcomes Instruction Video for completion of TCAM referrals and follow up form.

Discharge Medicine Service (DMS)

From 15th February 2021, the Discharge Medicines Service (DMS) became a new Essential service within the Community Pharmacy Contractual Framework (CPCF). This enables NHS Trusts to refer patients who would benefit from extra guidance around new prescribed medicines for provision of the DMS at their community pharmacy. The service has been identified by NHS England and NHS Improvement’s (NHSE&I) Medicines Safety Improvement Programme to be a significant contributor to the safety of patients at transitions of care, by reducing readmissions to hospital.

This service builds on the work that the Health Innovation Network undertook with Trusts and LPCs over recent years, as part of the Transfer of Care Around Medicines (TCAM) programme.

TCAM round table event

Health Innovation Wessex hosted a TCAM round table event in June 2021 to capture lessons learned from the national roll out.

A report from the event is available here, and you can see a recording of the meeting here.

For more information

Contact Lisa James, Senior Programme Manager, Medicine Optimisation

lisa.james14@nhs.net

*The TCAM image was designed by Health Innovation Wessex, and used with their permission

PINCER

Preventing prescribing errors with PINCER

Health Innovation KSS has been working to increase the use of a Pharmacist-led INformation technology intervention for reducing Clinically important ERrors (PINCER) in general practice since 2018.

A PINCER Progress Report was published in September 2020 giving an overview of the first 18 months of the national rollout of the programme, which can be found here.

More than 180 GP practices are now using the approach across Kent, Surrey, and Sussex. In addition to securing funds to support the programme following the end of the initial national commission with access to the software and PINCER resources, the health innovation network also provided training for those wanting to use the intervention and approach in practice.

Health Innovation KSS has secured continued access to the PINCER resource centre, which includes the PINCER searches (as well as the first of three training sessions) and access to the PINCER CHART online comparative analysis service, until 31 March 2022.

PRIMIS, the national lead for the project based at the University of Nottingham, is pursuing funding options via NHSE/I from April 2022 onwards.

The PRIMIS team will now manage any new registrations, which can be done in one of two ways:

The CCG can contact the PINCER team on pincer-team@nottingham.ac.uk with details of any pharmacists or practices wanting to access PINCER to get them added to the system, or
Any individuals wanting to sign up can be directed to the PRIMIS website. This page is going to be updated so when you click on Kent Surrey Sussex the user will be directed to the a self-registration page: PINCER Registration (office.com)

Training for new pharmacist will be available via Health Innovation KSS from February 2022 to April 2022. We will be running both ALS-2 and ALS-3 training sessions and will issue dates and details direct to those registered on the system.

For more information

Please contact us via kssahsn.medsops@nhs.net

POLYPHARMACY

MEDICATION REVIEW IN CARE HOMES

Problematic polypharmacy – when an individual’s multi-medication regime is not providing the intended benefit – can lead to adverse drug reactions and reduced quality of life.

The average older person admitted to hospital is prescribed 13 medicines and adherence is also poor resulting in significant waste of resources. Problematic polypharmacy is both a quality and patient safety issue.

Recognising this problem, Health Innovation KSS carried out a two-phase programme, looking at problematic pharmacy in care homes.

As a result of the work, a suite of resources has been developed to support organisations to implement a medication review service for citizens living in care homes.

Phase one

An initial six-month trial in Brighton funded a pharmacist and pharmacy technician to perform Level 3 (holistic face-to-face) medication reviews for patients at risk of medication related harm in care homes and their own homes.

It showed that this approach can prevent hospital admissions, offers savings to Clinical Commissioning Group (CCG) prescribing budgets, and is well received by patients and carers.

Phase two

Building on those learnings, the Health Innovation KSS team worked with East Surrey CCG, Crawley CCG, Horsham and Mid Sussex CCG and Sussex Community NHS Foundation Trust, all at different stages, to aggregate data from a wider geographic area, test findings, and consolidate learnings.

Resources

This work has resulted in the publication of a resource pack to support others looking to develop a similar approach, which includes:

Phase 1 evaluation report
Three detailed case studies from phase 2 and two accompanying analytical reports
Several resources and templates that can be adapted for local use, including:

Find out more

Health Innovation KSS will continue to support care homes with medication reviews via the national Health Innovation Network medicines optimisation team. kssahsn.medsops@nhs.net

STOMP

Health Innovation KSS evaluated work that took place in Bexhill on Sea that focused on stopping over medication of people with learning disability, autism or both (STOMP) – read the evaluation here. This is part of a national programme and is about helping people to stay well and have a good quality of life.

ME AND MY MEDICINES

The Medicines Communication Charter is a way to encourage conversations around medicines between the patient and their healthcare team to ensure the patient gets the best outcomes from their medicines.

Find out more on the Me and My Medicine website.

Health Innovation KSS is currently assessing interest in the use of The Medicines Communication Charter in our region and is a member of a national working group, looking to agree how to successfully implement this consistently.

For more information on this programme of work please contact Lisa Devine, Programme Manager lisa.devine5@nhs.net

MEDICATION SAFETY IN CARE HOMES

This work is now being delivered as part of our Patient Safety Collaborative’s Safe Medicine work. Find out more here.

Reimagining medicines information

Health Innovation KSS has worked with UK National Innovation Centre for Ageing (NICA), VOICE and Pfizer UK, with support from Unity Insights and National Institute for Health and Care Research (NIHR) Applied Research Collaboration Kent Surrey and Sussex (ARC KSS), to develop a new report ‘One size doesn’t fit all: reimagining medicines information for patients.’

The new report investigates the current medicines product information paradigm and whether it can be enhanced to more positively influence both patient experience of and adherence with prescription medication. Find out more about the findings and download the report here.