NPC - Medicines Management

This section of the website highlights some of the awards and recognition gained by teams participating in the medicines management programmes for their medicines management work.

Joel Hirst, a pharmacist and quality improvement facilitator in medicines and pharmacy at Bristol North Primary Care Trust, has won a “Leaders for change” award for a project that focuses on increasing the role of community pharmacists in the provision of local health services.

The project, one of 12 recognised by the charity The Health Foundation, involves a minor ailments scheme, innovative use of community pharmacists to provide enhanced services in public health and an increase in the number of pharmacists involved in the management of long-term conditions

Burntwood, Lichfield & Tamworth PCT won the Health & Social Care Awards 2005 Primary Care Professional of the Year Award for the Midlands and East Region. The award recognises the outstanding individual contribution from a primary care professional (including GPs, practice nurses, opthalmologists and optometrists, dentists and pharmacists) to work that has made a real difference.

Karen Rosenbloom and Ruth Goldstein have developed two key resources to support vulnerable people. Their first stream of work resulted in four trigger questions that identified people who had problems managing their medicines. These questions have been assimilated into the single assessment process for older people.

The second phase of this work has resulted in a comprehensive assessment tool to support community pharmacists' adherence to the Disabilities Discrimination Act (1995). This work has been developed to support the implementation of the new community pharmacy contractual framework and the National Service frameworks for older people and people with long-term conditions. The assessment tool allows pharmacy staff to assess actual need and to make reasonable adjustments to their services. People who are unable to use their medicines can be assessed for interventions to make sure that the support they are given is right for them.

The tool aims to encourage pharmacists to fully integrate with health and social care teams. Patients and carers are able, through the self-assessment form, to ensure that their needs are identified. This has enabled people to benefit who in the past have not been able to take or use their medicines.

Guildford & Waverley PCT won the 2005 NHS Innovations Award and where a finalist in the Southern Region for the Health & Social Care Awards 2005 Queen Mother's Award for the Care of Older People. They achieved this for an innovation called COUNT© (see below) developed by the PCT’s medicine management team.

Confused over how much medicine to take and when to take it
Over-ordering medicine – stockpiling, sharing, overuse
Unable to open packaging – to unscrew the lids on bottles or open foil packs
Not taking medicine – forgetting, or choosing not to take medicine
Too many or too few journeys – collecting medicines every week; access issues

The tool is used by non-medical and non-clinical staff to identify patients in their care who may have a problem with their medication. The team has provided training for the key workers in Intermediate Care and nurses in Key Care on how to use COUNT© to recognise signs of medication problems in their patients.

When these are identified, the key worker or nurse telephones a primary care pharmacist who visits the patient's GP, consults the patient’s medical records and discusses the case with the appropriate health professional. The pharmacist then visits the patient in their own home, accompanied by the initial referrer. A full medication review is conducted, discussing medication with the patient and carer or wider family; recommendations are discussed with the relevant professionals, and once they have been implemented, the patient’s medical records are updated.

As a further development the team have developed a model based on the long term conditions pyramid which focuses the work of the team on the complex patients at the top of the pyramid. However, it was recognised that a way of targeting patients at lower risk of being admitted to secondary care or needing Intermediate Care service or who may become high risk patients if they are not supported in how they take their medicines was needed. The new Community Pharmacist Contract provided a new opportunity to develop the tool and service through the essential services of repeat dispensing and self care and the advanced service for Medication Use Reviews (MUR).

The COUNT© tool was originally developed for non-clinical/professional staff which the team did not feel was sufficient for its new use. Due to the work with community pharmacists and nurses COUNT© has been further developed into a scoring system to help review patients abilities to take their medication over time.

An evaluation of the COUNT© tool and further information is available from the PCT.

Nottingham City Hospital NHS Trust won the Health & Social Care Awards 2005 Patient Safety Award for the Midlands and East Region. The award recognises the outstanding individual contribution from a primary care professional (including GPs, practice nurses, opthalmologists and optometrists, dentists and pharmacists) to work that has made a real difference.

The award was won for work they have done on the development and design of a patient-focused 'Patient's Own Medicines Bag' for use when patients attend hospital, their family doctor or any other healthcare appointment at which up-to-date medicine-related information is needed. The reasons they developed the medicines bag are:

In clear and simple terms, the bag effectively reminds the patient to take along all their regular prescribed medicines, together with any medicines purchased over the counter, to any appointment with a healthcare professional. It also reminds the patient to ask for up-to-date printed information. The bag acts as an interface tool between the patient and healthcare professional, ensuring effective dialogue and understanding on both sides.

Early development work has taken place which has covered PDSA cycles (Plan, Do, Study, Act); Quality assessments; Patient questionnaires; Walk-throughs; use of a Reporting toolkit provided by the National Prescribing Centre and one-to-one sessions with specific chronic disease management needs patients. Guidlines have now been produced for healthcare professionals and a “for professional use only” section has been added on the bag for recording known allergies or side effects, as it is absolutely crucial for such information to move through the system with the patient.

'How to Implement in your Trust' guidelines have also been produced allowing other trusts to start using the bags more easily.

In May 2003 Richard Seal and Gill Harvey from the NPC MMS team successfully submitted abstracts to the Institute for Healthcare Improvement (IHI) on “How the National Medicines Management Services Collaborative programme is helping to reduce the risk of problems related to medicines use” and were invited to present this work at the 8th European Forum

The presentation described how the National Medicines Management Services Collaborative (MMSC) programme was improving the way that medicines are used in England, and how Primary Care teams participating in the programme were reducing the number of medicines taken by, and improving medicines information for, patients.

The consequences of polypharmacy were discussed in detail and data collected by Wave 1 MMSC on the ‘average number of prescription items in people over the age of 65 years taking four or more medicines’ was used to demonstrate the improvement. (To see a chart displaying the data click here)

The improvements made by 1 st & 2 nd wave MMSC sites in their attempts to reduce the percentage of patients leaving the surgery with a prescription form for one or more items that have no specific dosage instructions were also shared . (To see a chart displaying the data click here)

At the same event Breeda Worthington, then a Development Manager with the NPC MMS team had a poster accepted on ‘Teamwork Improving Medicines Management’. The finished poster demonstrated how improvements in three of the programme measures were linked to team’s self-assessment scores.