:Connected care. Norfolk and Suffolk NHS Foundation Trust

Transcription

1 :Connected care Norfolk and Suffolk NHS Foundation Trust

2 An off-the-shelf Therapeutic Drug Monitoring system developed by the NHS, for the NHS. Clinicians Hospital GP Nurse Practitioner Requesting Doctor OUT OF RANGE ALERT Pathology Laboratory RESULT RESULT GP Patient information Access results Configurable NON RESULT ATTENDANCE ALERTS Clinical Pharmacy SystemTDM NPSA Compliant NICE guidance compliant REPORTING REMINDER Patient Test Patient involvement in care NOTIFICATION Pharmacists NPSA Compliant Web-based access Dispensing Commissioner NPSA compliance Assurance Cost effective Efficient Enables GPs and pharmacists to monitor and manage patients being prescribed therapeutic and high cost drugs NHS developed; reliable, secure, safe NHS compliant since 2003 Improves safety and reduces incidents; improves monitoring outcomes Cost effective and efficient Eliminates need to develop in-house systems at high cost Connects primary and secondary care; improves communications across care pathways Accessed by GPs and pharmacy consultants and District and General Hospital pharmacy services Involves patients in their own care Simple to set up, easy to use Meets National Patient Safety Advisory (NPSA) requirements

3 :CASE STUDY // Lithium monitoring in Norfolk since 2003 RESULTS OF THE SYSTEM TDM ON LITHIUM MONITORING RATES IN NORFOLK EFFECT OF SYSTEM TDM ON LITHIUM TESTING IN NORFOLK n= 3+ tests pa 2 tests pa 1 test pa 100% 90% POMH survey Norfolk before database Norfolk after database NUMBER PER YEAR (PATIENTS OR TESTS) % OF PATIENTS 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 or less 2 3 or more SERUM LITHIUM TESTS PER ANNUM SYSTEM TDM PRODUCED A LARGE IMPROVEMENT IN LITHIUM MONITORING FREQUENCY SystemTDM produced a large improvement in monitoring frequency over previous local practice, and has enabled maintenance of lithium usage in Norfolk. Prior to introducing the system in 1999, only around 700 out of 1500 patients attended for their three tests per year. After the introduction of the database system in 2003, around 1000 out of 1300 patients have regularly attended three tests per year. The generation of automatic reminders for patients is key in triggering higher rates of appointments, and ensures patients are involved in their own care. The system also generates alerts to GPs if patients fail to respond to reminders, enabling GPs to be proactive in patient care. SYSTEM TDM SHOWS CLEAR IMPROVEMENT OVER NATIONAL PRACTICE SystemTDM shows clear improvement over Prescribing Observatory for Mental Health (POMH) audit results (i.e. national practice). Compared to the quality and amount of lithium monitoring in Norfolk, over 80% of patients tested at least three times per year with 95% at NICE minimum frequency standards. This result clearly outperforms national survey results, which show only 48% of patients receiving three or more tests and over 30% of patients receiving one test or less.

4 :CASE STUDY (cont.) SYSTEM TDM HAS REDUCED THE NUMBER OF LITHIUM-RELATED SUIs IN NORFOLK TO ZERO The Prescribing Observatory for Mental Health (POMH) audit shows there were zero adverse safety reports in Norfolk during the reporting period. The expected number for Norfolk based on reported rates for similar catchments is 35. CONCLUSION: Active management of lithium monitoring using SystemTDM shows a marked improvement in performance over the long term. The system is effective, cost-efficient and helps improve patient care. In Norfolk, over 80% of patients tested at least three times per year, with 95% at NICE minimum frequency standards. OVERVIEW OF NORFOLK LITHIUM DATABASE ACTIVITY THE DATABASE PROCESS & UK NATIONAL GUIDELINES The National Patient Safety Agency (NPSA) issued an alert on lithium monitoring in December 2009 in response to high levels of incident reporting of lithium related events. This guidance (NPSA) refers to National Institute of Clinical Excellence (NICE) Clinical Guidance 38: Bipolar Disorder monitoring parameters for lithium. The NPSA guidelines are: Monitoring according to NICE Guidelines Reliable systems for test results between labs and prescribers Initiation with appropriate verbal and written information Blood tests monitored regularly, no repeats without safe testing assured Systems to detect drug-drug interaction Currently 1500 registered users Over 5000 registered users since inception Maintains register of all people taking lithium in Norfolk Send lithium blood test reminders to all patients every 3 months Sends up to three reminders, the third alerting the GP directly Ensures adequate information, education and access to specialist advice Is integral with a full shared-care agreement FIND OUT MORE: Contact Tim Anderson, Clinical Pharmacist tim.anderson@nsft.nhs.uk Call from UK: Call from outside UK: +44 (0) Norfolk and Suffolk NHS Foundation Trust

5 :INTRODUCTION A survey of lithium monitoring frequency in Norfolk in 2000 showed that less than 30% of patients received the ideal recommended four blood tests in a year, with 32% receiving one test only. In addition, 30% of patients had blood results outside the local agreed therapeutic range. As a result, a Therapeutic Blood Monitoring service (The TDM Database) was introduced in 2003/4. Since that time, national guidelines have been published in regard to the frequency and nature of lithium monitoring. The NHS in England and Wales has also introduced quality measures for lithium monitoring in Primary Care. The effect on lithium monitoring rates under SystemTDM when compared to national data is substantial. PRODUCT FEATURES AND BENEFITS Licence fee dependent on patient numbers Established system in mental health NICE/NPSA compliant Security Audit results Management reports Online patient access Set-up support Web-based Notifies patient of blood test dates and results Notifies GP and consultant of blood test results Produces Clinic lists IT Requirements Improved NICE/NPSA compliance for PCT/MH Trust Easily read data Maintains register of all lithium patients in catchment Sends blood test reminders to all patients every 3 months Sends up to three reminders, including direct reports to GP for continued non-attendance Ensures information, education and access to specialist advice (including online) Integral with a full shared-care agreement with GPs Multiple users enabled Configurable for individual patients SYSTEM TDM No NHS compliant IE7

6 Contact Tim Anderson, Clinical Pharmacist Call from UK: Call from outside UK: +44 (0) Website: Our partners: SystemTDM is proud to be supported by the UKs largest charity for bi-polar people, bipolaruk. bipolaruk endorses SystemTDM as best practice for bipolar sufferers taking lithium. To learn more about bipolaruk go to Copyright NSFT. SystemTDM software and literature are protected by copyright law and designright. SystemTDM is a registered trademark. All rights reserved.