Polypharmacy and anticholinergic burden Katherine Le Bosquet - - PowerPoint PPT Presentation
Polypharmacy and anticholinergic burden Katherine Le Bosquet December 2018 3 rd WHO Global Patient Safety Challenge Launched March 2017 WHO Global Patient Safety Challenge Reduce the level of severe, avoidable harm related to
Katherine Le Bosquet
December 2018
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WHO Global Patient Safety Challenge –
Reduce the level of severe, avoidable harm related to medications by 50% over 5 years, globally 3 early priority actions:
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“Patients and the public are not
always medication-wise. They are too often made to be passive recipients of medicines and not informed and empowered to play their part in making the process of medication safer”. “Systems and practice of medication are complex and often dysfunctional, and can be made more resilient to risk and harm if they are well understood and designed”.
“Health care professionals sometimes
prescribe and administer medicines in ways and circumstances that increase the risk of harm to patients”
"Medicines are sometimes complex
and can be puzzling in their names, or packaging and sometimes lack sufficient or clear information. Confusing ‘lookalike sound alike’ medicines names and/or labelling and packaging are frequent sources of error and medication-related harm that can be addressed."
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For the NHS to meet the needs of future patients in a sustainable way, we need to close three gaps:
Radical upgrade in prevention
Health and wellbeing gap
New Care Models and new support
Care and quality gap
Efficiency and investment
Funding and efficiency gap
Developed by the Care Quality Commission, Public Health England and NHS Improvement with the involvement of patient groups, clinicians and independent experts
However, quality, safety and increasing costs continue to be issues…
admissions are medicines related, many preventable
antibiotics through overuse which is a global issue
their medicines as intended, meaning their health is affected
increasing – over 1 million people now take 8 or more medicines a day, many of whom are older people
We spend £18.2 billion a year on medicines (£1 in every £7 that the NHS spends) and they are a major part of the UK economy
Due to people living longer, more complex and innovative medicines being developed, and more specialist medicines being used
5,000 10,000 15,000 20,000 Gross spend £m Primary care Hospital & community health sector Total
Medicines costs at list price (excl. VAT) before any discounts
spend 2016/17 was £17.4bn, an increase of 33.7% from £13bn in 2010/11.
was £18.2bn.
prescribed and dispensed in primary care rose from £8.6bn in 2010/11 to £9.0bn in 2016/17, a rise of 3.6%
in hospitals increased from £4.2bn in 2010/11 to £8.3bn in 2016/17, a rise of 98.3%
The NHS wants to help people to get the best results from their medicines – while achieving best value for the taxpayer
Savings will be reinvested in improving patient care and providing new treatments to grow the NHS for the future
The NHS policy framework that governs access to and pricing of medicines
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The commercial arrangements that influence price
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Optimising the use of medicines
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Developing the infrastructure to support an efficient supply chain
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A whole system approach….
Improvement, NHS Digital, Health Education England
ICSs, CCGs, and providers
AHSNs, Getting It Right First Time, NHS Right Care and NHSCC
Following the Next Steps on the NHS Five Year Forward View and Carter Report
www.england.nhs.uk
Four Regional Medicines Optimisation Committees (RMOCs), chaired by regional medical directors and supported by regional pharmacists Connecting CCGs and providers to take coordinated action Initial priorities:
primary care
www.england.nhs.uk
stop medication
access to inpatient medication information
any concerns about their medication
Set up following the recommendations of the Short Life Working Group
undergraduate training
medication errors
administration systems
PINCER
metrics
admissions
and develop solutions to prevent these being introduced
medicines
www.england.nhs.uk
Medication errors can include prescribing, dispensing, administration and monitoring errors. Medication error can result in adverse drug reactions, drug-drug interactions, lack of efficacy, suboptimal patient adherence and poor quality of life and patient experience An estimated 237 million medication errors occur in the NHS in England every year 68.3 million errors (28% of total) cause moderate or serious harm The estimated NHS costs of definitely avoidable ADRs are £98.5 million per year, consuming 181,626 bed-days, causing 712 deaths, and contributing to 1,708 deaths
EEPRU report - PREVALENCE AND ECONOMIC BURDEN OF MEDICATION ERRORS IN THE NHS IN ENGLAND November 2017*
WHO Global Patient Safety Challenge – Reduce the level of severe, avoidable harm
related to medications by 50% over 5 years, globally 3 early priority actions: polypharmacy, high risk situations, transfers of care
www.england.nhs.uk
www.england.nhs.uk
Appropriate polypharmacy: 'Prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised and where the medicines are prescribed according to best evidence.’ Problematic polypharmacy: 'The prescribing of multiple medicines inappropriately, or where the intended benefit of the medicines are not realised.’ When risks of medications outweighs the benefits for the patient
www.england.nhs.uk
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strategies
standards
non-medical problems
issues
and unrealistic expectations
and set clear therapeutic goals
drugs in older people
www.england.nhs.uk
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medication and clerking
www.england.nhs.uk
‘Problematic polypharmacy’ - prescribing of multiple medicines inappropriately, or where the intended benefit is not realised
items per head in 2016 was 20, compared to 14.8 in 2006
in a controlled way reduces the risk of medicines related complications and this requires clinical medicines reviews
vanguards have reduced these risks and the NHS is rolling out the Enhanced Health in Care Homes Framework and developing a medicines optimisation in care homes scheme October 2017 data: patients prescribed 10 or more unique medicines
https://www.nhsbsa.nhs.uk/sites/default/files/2018-02/PolyPharmacy%20Specification%20v1%200%20July%202017_0.pdf Accessed 05/12/2018