Medicine Support Service 23 rd March 2017 Helen Belben Medicine - - PowerPoint PPT Presentation

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Medicine Support Service 23 rd March 2017 Helen Belben Medicine - - PowerPoint PPT Presentation

Dec 04, 2022 100 likes •282 views

Medicine Support Service 23 rd March 2017 Helen Belben Medicine Optimisation Lead, SW AHSN Hayley Carr Pharmacist, NDHT Nerys Cadvan-Jones Pharmacist, Boots Rachel Nestel Pharmacist, Brannams Surgery Sue Taylor Chief Officer, Devon LPC

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Medicine Support Service 23rd March 2017

Helen Belben Medicine Optimisation Lead, SW AHSN Hayley Carr Pharmacist, NDHT Nerys Cadvan-Jones Pharmacist, Boots Rachel Nestel Pharmacist, Brannams Surgery Sue Taylor Chief Officer, Devon LPC

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Agenda

7.20 - Be seated. Phones on silent/Fire exits/Tweets & photos 7.30 - Welcome, Introductions & AHSN story – Helen Belben 7.40 - NDHT story – Hayley Carr 7.50 - GP Practice Process – Rachel Nestel 8.00 - Community Pharmacy Process – Nerys Cadvan-Jones 8.15 - Workshops 9.00 - Q&A - Which Patients? 9.30 - Finish

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Aim of the evening

  • Explain the Medicine Support Service
  • Provide an opportunity to try out the referrals and follow

up processes on PharmOutcomes

  • Provide a forum to network with your pharmacy

colleagues

  • You may wish to create a WhatsApp group to aid networking?
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The SW AHSN is dedicated to improving health and care, and spreading innovation across the region. We're part of a national network of 15 AHSNs, set up by NHS England to identify, adopt and disseminate innovative health and care. Our mission is 'to enable a sustainable health and care system for the South West by supporting and accelerating innovation and quality improvement'.

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What are the problems?

  • Evidence shows that when patients move between care providers

they are at risk of miscommunication and unintended changes to their medicines

  • Around 87% of patients have an unintended discrepancy in their

medicines discharge information which can lead to problems after hospital discharge and associated health consequences, many of which are preventable

  • Around 30-50% of medicines are not taken as intended by the

prescriber

  • Between 5-8% of unplanned admissions to hospital are due to

medication issues

  • £300 million of medicines are wasted each year
  • 1. http://www.rpharms.com/support-pdfs/3649---rps---hospital-toolkit-brochure-web.pdf
  • 2. http://www.rpharms.com/unsecure-support-resources/referral-toolkit.asp
  • 3. https://www.england.nhs.uk/ourwork/pe/mo-dash/background/
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What have we been doing?

  • Sept 2015 Our Medicines Optimisation Steering Group agreed this a priority area
  • Nov 2015 Begin discussions with LPCs and Acute Hospital Trusts in the South West
  • August 2016 Published our Implementation Support Pack
  • Meanwhile Newcastle, East Lancs, Bristol and Dorchester are working on similar

projects so advice sought from them

  • Research Article on the Newcastle Project in BMJ Open
  • Newcastle Hospitals Pharmacy Project receives an award
  • East Lancs NHS Trust developed Refer-to-Pharmacy
  • January 2017 Royal Cornwall Hospital launched fully automated referral system using

PharmOutcomes integrated function

  • Later in 2017 Other Devon & Somerset Trusts looking to begin
  • Possibility of National Research by Durham University - depends on successful funding

application

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Hospital Pharmacy

  • Need a novel approach
  • Faxes are not the best way to transfer

patient details

  • Paper copies of TTA not taken to community

pharmacy

  • Patients being readmitted due to continuing

to take stopped medication post discharge

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Why???

  • Keeping patient safe when they transfer between care

providers (RPS, 2011)

  • Hospital Referral to community pharmacy (RPS,2014)
  • Medicine Optimisation: the safe and effective use of

medicines to enable the best possible outcomes (NICE, 2015)

  • Medicine adherence: involving patients in decisions

about prescribed medicines and supporting adherence (NICE, 2009)

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Evidence for MSS

BMJ open article in October 2016

  • 2029 inpatients referred over 13 months via PharmOutcomes
  • 31% participated in follow-up consultation (228 MURs, 241

NMS)

  • Those who received a community pharmacist follow-up

consultation had significant lower rates of readmissions at 30,60 and 90 days post referral than those without a follow-up consultation

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Readmissions – data for 1386 referrals

Number of readmissions 0-30 days (%) 31-60 days (%) 61-90 days (%) Received a CP consultation (n=501) 29 (5.8) 17 (3.4) 18 (3.6) Did not receive a CP consultation (n=885) 142 (16.0) 84 (9.5) 83 (9.4)

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How it works?

  • Web based approach with long term aim to go fully integrated
  • Patient consents to Medicine Support Service
  • Discharge summary electronically sent on discharge by

hospital pharmacy

  • Community pharmacy receives notification e-mail
  • Referral viewed on PharmOutcomes
  • Referral acted on (or rejected) and outcome communicated to

hospital pharmacy via PharmOutcomes

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GP Practice Process

  • eDischarge received into patients EMIS notes and added to GP

document management list

  • Any follow-ups for GP are completed
  • GP/Pharmacist carries out Meds Reconciliation (within 72 hours)
  • Drugs stopped
  • Doses amended
  • New drugs added…….. ‘issue later’
  • Await contact from patient to request new items
  • eDischarge filed in patients notes
  • Going forward: Should a repeat be issued automatically?
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Community Pharmacy

  • An opportunity to capture Discharge MURs
  • Direct referral pushes patients to community Pharmacist
  • Simple process using Pharmoutcomes - Check daily/receive e-

mail

  • Arrange and carry out MUR
  • Set up a system to follow up next Rx - have the changes been

followed through?

  • A chance to work collaboratively with primary and secondary

care teams for the safety of our patients

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SLIDE 14

Workshop

  • Log in process
  • 4 discharge referrals
  • Compliance Aid – discharge MUR
  • Paediatric Patient
  • New Medication Service
  • Rejection
  • Discussion - What would you do with an error or discrepancy?
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Incentive

  • This is not a commissioned service - £5 incentive scheme for

the first 300 follow up forms

  • It is to help drive targeted MURs and NMS
  • Improve patient safety
  • Gives us useful information to provide a better service to our

patients

  • It is the way of the future when Community Pharmacy should

be more involved in pathways of care and allows better Pharmaceutical care

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SLIDE 16

Suitable patients

  • Compliance Aids
  • Discharge MUR – medication stopped
  • medication related admission
  • AKI
  • New Medicine Service
  • Maintain Patient safety
  • complicated regimes
  • high risk medications; diabetic, anticoagulation, CF,

immunosuppressant, unlicensed

  • Special medication – time efficient to share information

Log in on a regular basis to check referral

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Thank you

  • For further information please contact:
  • info@swahsn.com (reference MSS in North Devon)
  • Sue Taylor SueT@devonlpc.org
  • Primary Care Pharmacy Communications ndht.pcpc@nhs.net