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Optimism? Optimisation? Opportunity?

Steve Brown Director of Pharmacy, University Hospitals Bristol NHS Foundation Trust Associate Director Medicines Management NHS South West. Optimism? Optimisation? Opportunity?. NHS spend > £11 billion pa on medicines £300 million pa wasted 50% of waste is preventable

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Optimism? Optimisation? Opportunity?

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  1. Steve Brown Director of Pharmacy, University Hospitals Bristol NHS Foundation Trust Associate Director Medicines Management NHS South West Optimism?Optimisation?Opportunity?

  2. NHS spend > £11 billion pa on medicines £300 million pa wasted 50% of waste is preventable 30-50% of medicines not taken correctly 10 days after starting a new medicine 30% of people non adherent 6.5% adult hospital admissions may be medicines-related 30% of these: non-adherence to medicines for LTCs 2008/9: >543,000 bed days in England & Wales due to adverse events caused by medicines - cost >£235 million Opportunity knocks?

  3. The opportunity – cost / benefit / harm The Points

  4. Controlling medicines spend Managing high cost medicines Reducing medication related incidents Managing risks and governance Meeting CQC outcome 9 / NHSLA standards Maximising cost-effectiveness Reducing waste Reducing readmissions Opportunities:organisational

  5. Controlling medicines spend Embed generic switches Managing high cost medicines Immunoglobulin management Reducing medication related incidents Local incident review Drug prescribing labels Tacrolimus – Prograf IV …… mg daily continuous iv infusion Starting dose; 30micrograms/kg/day. NB Reduce dose for patients on azole antifungals- discuss with pharmacist. Dilute to 4-100microgram/ml in saline 0.9% or glucose 5%.Use PVC free bags and line. Monitor levels. Opportunities:local

  6. Managing risks and governance ED simulation exercise Meeting CQC outcome 9 / NHSLA standards Prescribing audits Maximising cost-effectiveness Formulary guidance Reducing waste Formulation guidance Reducing readmissions Contact details on discharge summaries Opportunities:local

  7. The opportunity – cost / benefit / harm QIPP is more than CIP The Points

  8. QIPP– Challenge or Solution? • Quality • Innovation • Productivity • Prevention

  9. High Quality Care for All: 2008-2018 • Safety • Outcomes / effectiveness • Personal / patient experience

  10. Safety

  11. 5% of SUIs from incorrect settings on infusion pumps Wrong dose: Safety

  12. The opportunity – cost / benefit / harm QIPP is more than CIP Focus on optimisation The Points

  13. NHS White Paper 2010 3.22 Pharmacists, working with doctors and other health professionals, have an important and expanding role in optimising the use of medicines and in supporting better health. Pharmacy services will benefit from greater transparency in NHS pricing and payment for services

  14. Pharmacy White Paper 2008 Pharmaceutical care elements include a full medication review aligned with NICE guidance and local prescribing advice and policies, optimisation of the drug regime including reference to the use of OTCs and eradication of food / drug interactions

  15. A renewed emphasis on the patient being at the centre of all we do, helping them (or their parents) become experts in their own medicines, supporting self care, and involving them in decision-making. This will help to ensure that patients achieve the best possible outcomes and the NHS achieves value for money from the investment in medicines. Medicines optimisation must also be delivered in the context of supporting better health. Medicines Optimisation 1

  16. Medicines optimisation encompasses all aspects of the handling of medicines that enable patients to achieve the maximum health gain and least harm from their medicines Prescribing Consultants Resources Medicines Optimisation 2

  17. Safety Avoid harm from medicines Governance - safe and secure use of medicines Learning from errors and incidents Effective Outcomes Optimal outcomes from NICE guidance or best evidence Value for money from medicines All health professionals understand their responsibilities Patient experience Decisions made jointly and patients/parents are fully informed Support is available across all interfaces Access is robust, transparent and in accordance with NHS Constitution Medicines Optimisation 3

  18. The opportunity – cost / benefit / harm QIPP is more than CIP Focus on optimisation The return on investment The Points

  19. NHS Outcomes Framework: Domains • Preventing people from dying prematurely • Enhancing quality of life for people with long-term conditions • Helping people to recover from episodes of ill health or following injury • Ensuring that people have a positive experience of care • Treating and caring for people in a safe environment and protecting them from avoidable harm

  20. The opportunity – cost / benefit / harm QIPP is more than CIP Focus on optimisation The return on investment The critical role of the Pharmacy specialist The Points

  21. Where are we?

  22. The opportunity – cost / benefit / harm QIPP is more than CIP Focus on optimisation The return on investment The critical role of the Pharmacy specialist Optimism? The Points

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