The Pharmaceutical Journal
Vol 272 No 7293 p409
3 April 2004

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How medicines management is set to be improved in hospitals in England

Funding to improve medicines management in 20 hospitals has just been announced. Clare Bellingham (on the staff of The Journal) reports

After the success of the medicines management collaborative projects in primary care, the scheme is poised to take off in hospitals. The Hospital Medicines Management Collaborative aims to optimise medicines management systems.

A team based at the National Prescribing Centre will be responsible for developing and implementing the Hospital Medicines Management Collaborative. It will support the project teams from each of the hospitals, providing training and technical advice about medicines management.

The first 20 hospitals that will benefit from this approach were announced last weekend at the Guild of Healthcare Pharmacists conference. Speaking at the conference, health minister Rosie Winterton said that £800,000 will be invested in the collaborative, or £40,000 for each participating hospital. “This extra investment in new ways of working, that break down traditional barriers and get the best from the whole clinical team, will produce real benefits for the millions of patients who are treated by the NHS every day,” she said.

Richard Seal, director of medicines management at the NPC, commented: “Our ultimate goal is to enable hospitals and their patients to make the best possible use of medicines. We will work towards this goal by helping local hospitals develop their own solutions to the medicines management challenges that they face, learning from existing good practice in the process.”

What the programme involves

What is the Hospital Medicines Management Collaborative about? It has five aims: to help patients and hospitals to get the best from medicines, to optimise patient care, to improve communication about medicines management, to increase multidisciplinary involvement in medicines management and to improve the clinical and cost-effective use of medicines. Some of the objectives include making more use of technology, and better management of use of non-formulary items, unlicensed medicines and off-label drug use.

A collaborative approach to achieving these aims will be taken. This means that each hospital will identify what medicines management issues it faces, identify best practice that could improve these issues, adapt the best practice to local needs and then adopt this practice within the hospital. It is also about sharing good practice with other participants and learning from it, as well as learning from those ideas that are less successful.

This collaborative approach means that what each individual hospital will do within the programme is not set out by either the Department of Health or the NPC: it is up to the hospitals. Since the programme is only just beginning, the hospital teams themselves do not know the exact details of the approach they will take. What is known is that the programme should help hospitals to meet the recommendations set out in several documents, including the “Medicines Management Framework”, “A spoonful of sugar” and “Making a difference: reducing burdens in hospitals”.

In order to achieve these objectives, the hospital teams will be involved in an 18-month programme of events co-ordinated by the NPC. The hospital teams will have to collect data about the improvements they implement. Each month they will be expected to study, report and act on these data. This means that ideas that work, and those that do not, will be recognised quickly.

The hospitals involved have got some ideas of what they would like to achieve through the Hospital Medicines Management Collaborative programme.

John Martin, chief pharmacist at Yeovil District Hospital, East Somerset NHS Trust, says: “It will provide a wonderful opportunity for us to raise the profile of medicines management and to increase the rate of implementation of medicines management. But most importantly, it will be great for patients: they will notice a huge improvement in services.” He plans to concentrate on dispensing for discharge and self-administration of medicines. “We need to make sure that we get these introduced on all wards where the patient is capable,” he explains.

At Kettering General Hospital, two areas have been highlighted: improving communication across the primary/secondary care interface and management of the introduction of new drugs. Sue Manktelow, associate director of pharmacy, explains: “For the communication aspects, this will involve improving discharge medicine arrangements on the accelerated discharge unit and looking at sending electronic discharge summaries to GPs.”

And at George Eliot Hospital in Nuneaton, chief pharmacist Surinder Bassan says: “Our concerns are around improving access to medicines and medicines information, and the fact that we fail patients by not following them up after discharge. We have made some attempts to improve these by setting up diabetes and heart failure clinics but I would like to extend this to a wider range of cardiovascular conditions.” He hopes it will be possible to follow patients up one month after discharge in order to identify any problems that they might be having. In addition, an improved medicines information service is planned, for example introducing a patient telephone line for drug information.

The Hospital Medicines Management Collaborative programme looks set to improve medicines management significantly in the 20 selected hospitals. But the impact will be felt more widely once the findings from the programme are shared across hospital pharmacy.