Medicines Management Team Update

Transcription

1 Medicines Management Team Update

2 Medicines Optimisation in 2017 Deprescribing/reducing variation Care homes Dietetics Improving Clinical outcomes e.g. reducing stroke, Antibiotics Joint Formulary Responses to national consultations

3 Polypharmacy & Deprescribing Medicines: stop, start or continue programme launched Polypharmacy and Deprescribing elearning launched Toolkits to support primary care prescribers launched on: Dosulepin Identifying frailty Medicines optimisation to reduce falls risk Medicines optimisation to reduce risk of low HbA1c Omega 3 Reducing overprescribing for people with learning disabilities (in progress) An EMIS (Egton Medical Information Systems) template making it easier for primary care prescribers to signpost to appropriate interventions to support frail older people live independently launched A polypharmacy and frailty stakeholder group was formed and strategic plan completed

4 Care homes Medication review have been carried out for 353 residents Reviews have resulted in o o o o 357 medicines being stopped for at least 50% of residents 41 interventions on medicines to reduce the risk of a fall 37 interventions on medicines that have high risk of causing admission 15 medication errors identified and resolved that have high or extreme harm risk o Total savings from medicines stopped & admissions prevented is estimated as 52K Systems and processes reviewed in 19 care homes with a total of 931 bed capacity (approx. 25% of Bucks care homes) 75% of care homes reviewed demonstrated quality improvement on at least 6 National Institute of Clinical Excellence (NICE) medicines standards Implemented of the standard monthly ordering process and waste reduction guidance in 19 care homes had resulted in 49k savings

5 Care homes Education and Training Sessions ; monthly webinars and registrars training at Amersham community hospital Developed medicines management care homes websites on both Chiltern and Aylesbury Vale CCG website CCG care homes medicines optimisation in partnership with Bucks Quality in Care Team (QICT) and Buckinghamshire Healthcare NHS Trust Community Geriatrician was shorted listed for the HJS awards 2015 & 2016 Care home work has led to having a Joint post for Interface Pharmacist for Older people to develop a seamless medicines optimisation service across the ACS for older people.watch the space! I am looking forward for all future webinars. I found it knowledgeable and helpful, and time and money saving as no travel is required. Agata Met- Deputy Manager at Swarthmore Residential Home I just wanted to say thank you for the work you did at Woodland Manor. The prescription ordering process is much better now, and the number of inappropriate faxes we receive have significantly reduced. Thank you again- Dr Maria Easaw GP at The Allan Practice The home was working on improving the service to people with health conditions by engaging in the Medicines Review in Care Homes project, supported by the AVCCG and CCCG This involved a review of people's medicines by a pharmacist and the GP. In doing so people were protected from the risk of taking inappropriate medicines. CQC Inspection report on Hamilton House published 21 st Feb 2017

6 Outcomes of improved diabetes training in care homes: 150 people are now competent to do blood glucose monitoring, recognise and treat hypoglycaemia 45 Residential Homes sent 123 staff for training 25 Nursing Homes sent 71 staff for training 100% of staff that attended registered an increase in knowledge and confidence in managing diabetes 100% of staff identified key change/s they plan to make in their practice Local Geriatrician now undertaking audits to identify patients at risk of hypoglycaemia De-prescribing toolkit developed to support GP s and Practice Nurses to identify residents at risk of hypoglycaemia, hospital admissions and cardiovascular events due to low HbA1c.

7 Prescribing Support Dietitian 2 national care home e-notes systems advised re errors in Malnutrition Universal Screening Tool (MUST) calculation systems amended One of 1 st CCGs to produce guidance on blended diet for paed tube feeding Interventions Joint Multidisciplinary Team working across CCGs, BHT acute and community, Florence Nightingale Hospice, care homes to produce Palliative Comfort Feeding guidelines Outcomes Adoption of new direct referral from care homes to BHT Dietitians across county Plan for joint working with Carers Bucks to share message that low weight/ unplanned weight loss in old age is malnutrition & treatment can improve health & quality of life Correct recognition = improved treatment of malnutrition Support for colleagues working with parents who have chosen this feeding method; savings on prescribed tube feeds Can help reduce unnecessary acute admissions & inappropriate requests for tube feeding in last year of life Reduction in inappropriate referrals; reduced GP workload; empowered care homes Improved recognition & treatment can maintain independence & avoid unnecessary acute admissions

8 Dietetic Assistant Practitioner - Malnutrition Universal Screening Tool (MUST) training MUST training delivered to 257 staff in 22 care homes - Improved MUST completion - Residents body weight improved/ & nutrition care planning maintained

9 Senior Clinical Pharmacist Advisor Provide clinical support to meet national targets in Reduction of inappropriate antibiotic prescribing for Urinary Tract Infections (UTIs) in primary care Key Interventions Produce joint BHT /CCG formulary guidance on prescribing Continence appliances in Bucks & supply of discharge packs for patients requiring catheterisation Outcomes Promotion of benefits & safe prescribing of oral anticoagulation (OAC) in pts with AF at high stroke risk who are either receiving no or inadequate anticoagulation through education & clinical support initiatives inc excellence in Atrial Fibrillation (AF) project Significant reductions in inappropriate use antibiotics & consistently meeting CCG Quality premium targets Facilitated clinically appropriate cost effective choices prescribed to maximise clinical benefit whilst also containing prescribing costs across the ACS. Improving the quality of care across boundaries through introduction standardised catheter care pack ast point of discharge Overall reduction in number of high risk AF patients now not receiving OAC cover and corresponding reduction in no AF related strokes seen (ref Systolic Neural Network Accelerator on Programmable logic SNAPP data). Majority of practices achieving OAC rates > 85% and in top the best performing CCGs

10 90.00% Oral Anticoagulation % Uptake* in AF Pts With CHA 2 DS 2 VASc score 2 or 1 if Male * Av 6 monthly figures taken from Grasp AF practice data 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% Jan-13 Sep-13 Mar-14 Aug-14 Feb-15 Aug-15 Jan-16 Jul-16 Feb % AVCCG Chiltern CCG Bucks Total

11 Joint Bucks Formulary and Guidelines Maintaining Bucks joint formulary and clinical guidelines to deliver consistency to our population in terms of clinically effective use of medicines.

12 Chronic Obstructive Pulmonary Disease (COPD) guideline

13 Formulary and Guidelines Support work 2017 Vitamin D in children guideline published Updated guideline on COPD Melatonin shared care protocol Updated guideline on Attention deficit hyperactivity disorder (ADHD) and new treatments Treatment of psychoses and schizophrenia

14 Working across boundaries Sharing of all work with Sustainability and Transformation Programme (STP)/Thames Valley CCGs e.g. dietetic guidelines Agreeing joint Shared Care Protocols across Thames Valley initially in Rheumatology Joint commissioning meeting to optimise management of high cost drugs outside of tariff Supporting Public Health in re-procurement and implementation of Substance Misuse service Working with Oxford Health to align Joint formulary with Mental Health trust

15 Prescribing Budget Both CCGs in best 12 CCG nationally in terms of Cost/standardised patient M8 forecast estimated underspend of > 200k However NSCO national cost pressure due to drug shortages are now > 3m for Bucks CCGs which will forecast an overspend of approx. 1m

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18 Medicines Optimisation 2018 and beyond Joint posts across CCG/BHT e.g. Care of elderly Joint working with Fed Bucks e.g. Flu plan Medicines optimisation ACS board new joint committee to oversee aligned projects and provide assurance that legal, financial and clinical outcomes are met Medicines optimisation stakeholder engagement event held to identify key system priorities; Single point of access for medicines recourses Improved transfers of care Reduced waste

19 Waste Excess Medication Qty Cost Nefopam Tab Seretide 250 Evo AgaMatrix Jazz Wave Strips (50) Zapain 30/500 Tablets Aerochamber Plus Zamadol 100mg SR Caps Carbocistene Caps Domepridone 10mg Tab Eumovate 100mg Cream Gabapentin 100mg Cap Ferrous Fumurate 210mg Gabapentin 300mg Cap co-amoxiclav 500/125 tab Total

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21 Summary of ACS projects Elderly care including dosette boxes Deprescribing Reducing variation Biosimilars Anti microbials Waste Generic meds 2ndry Transfer of Care Single point of access MO Potential Non FP10 supply (catheter, stoma wound care) Insulin pump management process Strategic place of home care

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23 Thank Any Questions? You!