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Mr Seal is director of medicines management at the National Prescribing Centre, Liverpool |
One only has to look through the pages of past issues of Hospital
Pharmacist to realise that there are lots of examples of good medicines management
practice already taking place in hospitals in different parts of the
country. These tend, however, to occur in “pockets of excellence”,
at trusts where medicines management has been fully integrated into the
organisations’ core business. What we need to do is to make this
existing knowledge more explicit and spread it to other organisations.
Recent publications1-3 highlight the need to improve hospital medicines
management. By sharing what we already know works well, changes can be
made more easily and improvements accelerated.
This collaborative approach to improving medicines management, which
has a proven track-record, is the one advocated by the medicines management
team based at the National Prescribing Centre in Liverpool.The team was
set up in 2001 to help support primary care organisations make improvements
in medicines management services. It is currently working successfully
with 146 primary care trusts across England with the potential to improve
medicines management services for around 27 million people.
Early in 2003, the Department of Health approached the national team
to put together a collaborative programme to provide similar support
towards improving medicines management
services in hospitals. This involves:
· Developing, through an advisory panel, a set of
principles, ideas and actions for medicines management which would lead
to
significant improvements if they were implemented across all NHS
organisations.
· Presenting these ideas and using management
techniques to enable trusts to apply the lessons learned to their own
local situation.
· Sharing and encouraging the adoption of successful improvements across
the wider NHS, for example, to other hospital trusts,
primary care trusts, primary health care teams, GP
practices, community
pharmacies, mental health trusts and within social care settings.
Acute hospital trusts in England were invited to join the programme
in the autumn of 2003 through a rigorous application process and the
20 successful sites were announced in March 2004.4 Each participating
trust is to receive £40,000 to support their involvement in the
programme and to recruit a local facilitator. The idea is that they send
multidisciplinary project teams of around 11 people to a series of national
collaborative workshops and learning events.
These national events are interspersed with periods of locally-based
activity designed to test and implement small changes to existing ways
of working. Although each team contributes to the overall goal and aims
of the programme (see below), they set their own objectives and action
plans in line with local priorities.
As improvements are made, they are shared widely both within and outside
the programme, thereby improving access to the ideas that work as well
as those that do not.
All 20 sites taking part in the programme will work towards a single
common goal. In the hospitals’ medicines management collaborative
this will be: “To optimise medicines management systems within
the hospital service to ensure safe and informed outcomes of patient
care.” This goal is supported by five more specific aims, namely:
· To help patients, and the hospital trust,
get the best from their medicines,
identifying and addressing unmet pharmaceutical need, and thereby delivering
real improvements in health.
· To optimise patient care in accordance with accepted
local and national guidance, thus improving links between medicines
management and clinical governance within the trust.
· To improve communication systems for the dissemination of information
on medicines management throughout the hospital trust and beyond.
· To increase multidisciplinary involvement in medicines
management and make best use of the skills of the
pharmacy team.
· To develop medicines
management approaches that increase the clinical and cost effective use
of
medicines, thereby
increasing service efficiency and reducing waste while keeping the patient’s
needs uppermost.
The first event for the first wave of participating trusts will take
place in June 2004 and so it is not yet possible to say what new ideas
will be worked on. However, it is likely that
multidisciplinary working, improving communication about medicines and
redesigning existing medicines management processes will feature prominently.
Crucially, as the programme develops, details of the learning and experiences
will be made available on the medicines
management section of the National
Prescribing Centre website. The National Prescribing
Centre team will also be organising events to help share the lessons
learned.
Medicines play a major role in modern health care. While their influence
is generally positive, we all know that this is not always the case — for
example, up to 25 per cent of admissions to hospital in people over the
age of 65 years can be attributed to a medicines-related cause.5 Working
together to find innovative solutions can no doubt lead to better medicines
management and help improve this statistic.
References
1. Audit Commission. A spoonful of sugar: medicines management
in NHS hospitals. The Commission: London; 2002.
2. Regulatory Impact Unit –– Public Sector Team. Making a
difference — reducing burdens in hospitals. The Unit: London; 2002.
3. Department of Health. Medicines management in hospitals performance
management framework. London: The Department; 2003.
4. Minister announces boost for medicines management. Hospital Pharmacist
2004;11:125.
5. Department of Health. National Service Framework for Older People.
The Department: London; 2002. |
Hospital Pharmacist