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;

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

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

For more information

Contact Lisa James, Senior Programme Manager, Medicine Optimisation lisa.james14@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, and Medway NHS Foundation Trust.

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

For more information

Contact Lisa James, Senior Programme Manager, Medicine Optimisation

 lisa.james14@nhs.net  

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

PINCER

Preventing prescribing errors with PINCER

This is one of seven programmes selected for national adoption and spread across the AHSN Network during 2018-20.

Prescribing errors in general practice are an expensive, preventable cause of safety incidents, illness, hospitalisations and even deaths. Serious errors affect 1 in 550 prescription items, while hazardous prescribing in general practice contributes to around 1 in 25 hospital admissions.

In 2017, the World Health Organisation (WHO) launched a Global Patient Safety Challenge: Medication without Harm with the aim of reducing the level of severe, avoidable harm related to medicines by 50% over the next five years, globally.

In Kent, Surrey and Sussex, we are increasing the use of a Pharmacist-led INformation technology intervention for reducing Clinically important ERrors (PINCER) to meet this challenge.
The PINCER approach supports GP practices using software systems alongside root cause analysis to identify why mistakes happened and follows a quality improvement approach to tackle these issues ensuring action is taken to reduce the risk of these errors occurring.

In the region where it began, 2.9 million patient records were searched and 21,636 instances of potentially hazardous prescribing were identified using 11 prescribing indicators. It is estimated that approximately half of these needed an intervention to avoid harm, cases that could otherwise have been missed.

Results showed that as a result of the study there was a significant reduction in hazardous prescribing for indications associated with gastrointestinal bleeding, heart failure and kidney injury. An economic analysis showed introducing PINCER was cost effective, demonstrated an increased quality of life for patients, and gave an overall reduction in costs for practices. Overall, medication error rates were reduced by up to 50%. It has now been spread to other parts of the country with improved technology and a total of 13 indicators.

KSS AHSN is supporting the regional roll out of PINCER, including providing support for the implementation of the software and training. 

It is anticipated that use of PINCER will result in a reduction in serious medication-related adverse effects, a significant improvement in prescribing safety in primary care and cost savings to the NHS both at practice level and by preventing any hospital admission related to an adverse effect.

When practices are fully trained, it is expected that PINCER will be run twice a year allowing them to benchmark themselves against others both locally and nationally.

Training has taken place in Kent, Surrey and Sussex with nearly 200 practices signed up with PRIMIS and baseline data being uploaded by practices across the region.

Due to COVID-19, training sessions in March and April were postponed but these will be rescheduled in due course and these dates will be communicated out.

PRIMIS has also developed new free searches to help practices identify patients who may be at increased risk of hospitalisation, in order to ease pressure on secondary care. These focus on asthma & COPD, high-risk GI bleed and medication safety where NSAIDs are potentially harmful. More information on these searches – including links for both EMIS Web and TPP SystmOne targeted searches – can be found here.

For more information

Contact Lisa Devine, Programme Manager: lisa.devine5@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, KSS AHSN 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 KSS AHSN 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:

Find out more

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

STOMP

KSS AHSN 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.

KSS AHSN 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

Medication errors are a common issue within the care home sector, impacting on the health and wellbeing of residents as well as adding additional challenges for care home staff and managers to overcome.

The KSS AHSN Medicines Optimisation (MO) team is supporting the PSC Medicine Safety in Care Homes programme, the first stage of which was to engage with a representative sample of care homes and stakeholders via an electronic survey and direct conversations to understand the reasons for medication errors and how these could be avoided in the future.

This baselining exercise culminated in the development of a KSS-wide report, which was fed into a national report, for review by the Medications Safety Improvement Programme board. The national report is available here.

The national findings will be used to develop a national commission, originally expected in April 2010. In light of COVID-19 however, priorities have been readjusted nationally and this programme of work currently on hold.

For more information contact Lisa Devine, Programme Manager: lisa.devine5@nhs.net.