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Oxford medicines optimisation presentation

  1. Medicines Optimisation Richard Harris MRPharmS 21/11/2016 1
  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 21/11/2016 2
  3. Clinical Screen (Identify) Best Practice (Plan) Medicine Optimisation (Action) Review Outcomes (Evaluate) Patient 3
  4. 21/11/2016 4 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
  5. 21/11/2016 5 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
  6. 21/11/2016 6 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
  7. 21/11/2016 7 •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? 8 Thank You

Notas do Editor

  1. Helping care home rehabilitation staff with medicines management
  2. Rivastigmine Patch Switch where appropriate to capsules-cost saving
  3. Step one: Agree protocol Step two: Patient identification and data collection Step three: Exclusion criteria – patients NOT suitable/eligible for stopping prescribing of omega-3 fatty acid compounds Step four: Stop prescription for omega-3 fatty acid compounds in reviewed patients Step five: Summary report to GP practice Step six: Follow up