This document discusses medicines optimisation, which aims to identify, intervene, and resolve issues with adverse medication performance, inappropriate prescribing, and non-compliance. The goal is to improve treatment outcomes for patients, improve value for the NHS, and ensure optimal and safe treatment based on evidence. Pharmacists can contribute by ensuring safe prescribing adheres to best practices, assessing drug histories for issues like polypharmacy, optimizing drug therapy, providing medication education, and coordinating information for patients. A case study examines a high-risk elderly patient taking multiple medications and proposes recommendations like reviewing medications like diuretics and shorter-acting benzodiazepines to reduce falls risk.

1. Medicines Optimisation
Richard Harris MRPharmS
21/11/2016
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2. Medicines Optimisation Aim
Identification, Intervention and Resolution of
adverse medicines performance, inappropriate
prescribing and compliance issues
 Improve Treatment Outcomes for Patients
 Improve value for money for the wider NHS
 Improve quality, safety & optimal treatment
outcomes based on best evidence
 Patient Engagement
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3. Clinical Screen
(Identify)
Best Practice
(Plan)
Medicine
Optimisation
(Action)
Review
Outcomes
(Evaluate)
Patient
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How Can Pharmacists Contribute ?
 Ensure safe prescribing & administration of medication that adheres to
best evidence & practice
 Cost effective-QIPP drop lists -drugs of limited clinical value
 Assess Drug History & Monitor for Polypharmacy/ prescribing cascades
& ADEs-Document-Communicate-Challenge
 Optimise Drug Therapy- Switching/ patent expiry
 Medicines waste campaigns e.g. patient education awareness
 Medicines Optimisation Training (MDT/GP Practices/ Care Homes)
 Provide co-ordinated medicine information to patients/carers/relatives
as part of the discharge-planning process

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Case study - Elsie 78
• Recently discharged from hospital after a fall
• She lives alone
• Elsie says her mobility and eye sight are getting worse.
• Takes Furosemide 40mg BD –doesn’t like ‘water tablet’
• Recently prescribed Nitrazepam to help poor sleep.
• Reports feeling thirsty
What Are The Risk Factors?
• Age
• Falls history
• Adherence concerns-cognitive/physical
• New medication
• Undiagnosed disease?
• Isolation
Supporting Medicines Optimisation & reduce further falls
• Is diuretic suitable? Consider recommending an alternative
• Switch to a shorter acting benzodiazepine e.g. Zopiclone - consider cessation
• Increased thirst may suggests undiagnosed diabetes-referral
• Is Elsie managing to take her tablets OK on her own?- Ask the patient-check her
medicines with her-advise on correct use - consider compliance aid
• Wider question over independence : Engage with MDT/arrange care package

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Case Study : Omega 3 Low Priority Poor Value
The NHS Midlands and East spent £2.5 million on omega-3 fatty acids compounds in 2012-2013
Source: PrescQIPP Bulletin 47 October 2013
NICE Guideline-Evidence base
PrescQIPP Drop List
Letter of Advice/PIL to Patient
Agree protocol/process
Audit practice/patients
Monitor savings -
summary report
Omacor
I capsule daily =
28 day saving of
£14.28
Medicine Stopped
Pharmacist CCG
Medicines Review
Optimisation

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•Prioritise:
• Engage the patient in the process
•Aim:
• Keep regimes as simple as possible-reduce pill burden
•Modify:
• Make recommendations including cessation- “is the drug still
needed?”
•Prevent :
• Adherence issues-check patient understanding, Identify & resolve
barriers, explain & monitor changes
Presentation Summary

8. Any Questions?
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Thank You