Medicines Optimisation
Richard Harris MRPharmS
21/11/2016
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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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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

Any Questions?
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Thank You