Medicines
Management
Issue no 5, p10
September/October
2002
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Medicines
Management |
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Features |
Managing medicines: keep on talking
Mendip Primary Care Trust was one of 26 sites in the first wave of medicines management pilots selected to participate in the National Prescribing Centre's collaborative programme. New funding allowed the appointment of a full time medicines management facilitator, Karen Taylor. Mrs Taylor has focused on a group of eight pilot practices, looking in particular at repeat prescribing issues. She emphasises the differences between the practices — some have staff dedicated to repeat prescribing, while in others new staff with little prior knowledge are involved. She has aimed for small, gradual changes in practice, with ideas and outcomes shared with both her practices and nationally among other collaborative sites. This is the essence of the collaborative approach — a proven methodology for quality improvement. Key aims of the projects involved: • Synchronisation of orders — so that patients receive the correct amount of medicines at the correct time, and allowing original pack dispensing where possible • Reducing prescriptions with non-specific directions — so that patients always have clear directions on how to take their medicines • Increasing medication review, particularly for patients at risk of an adverse drug reaction, such as those in a nursing home, and those over 65 on four or more medicines As a pharmacy technician who has managed services in a busy district general hospital, Mrs Taylor is eminently practical and sympathetic to the time pressures of practice and pharmacy staff. "Problems in the practice are also likely to be reflected in problems in the pharmacy, but those involved may not get to speak to each other," she says. Mrs Taylor has helped to develop relationships between staff in GP practices and pharmacies. "Having community pharmacists coming into GP surgeries to carry out medication reviews has provided opportunities for communication that wouldn't have previously occurred. Pharmacists' and GPs' schedules mean they have little opportunity to meet face to face. The project facilitator can help to keep the programme moving along by sorting out practical and formal details, for example computer data entry systems, feedback mechanisms and contracting," she says. Working together Experiences and ideas have been shared at "process mapping" workshops where staff working in practices on repeat prescribing come together as a group to examine system processes in detail. Other meetings have included individual practices and their local pharmacy staff. "I hope to build on this work spreading into the wider multidisciplinary team working by involving other people involved, such as nursing home staff, and community and practice nurses," Mrs Taylor says. As expected, interventions work best where good professional links are developed. Mrs Taylor has facilitated a feedback system in which pharmacists alert practices to repeat prescriptions in which quantities are not synchronised. Practices have also learned how to make better use of their clinical systems, regarding repeat prescriptions, for example, deleting items that have not been ordered for at least a year. The project has also enabled a pharmacy-GP electronic link to be set up in one centre. One of the main features of the scheme is the funding of pharmacists to provide advice to GPs and carry out medication reviews. One pharmacist is also carrying out domiciliary visits. Pharmacists can alter quantities and doses, based on previously agreed protocols, and may stop items on repeat prescriptions. Although it was set up as an "improvement" rather than a "research" project, Mrs Taylor says that tangible benefits can be seen. A brief analysis of medication reviews found that these had already saved half the money that they had cost — notwithstanding the quality improvements for patients. Mrs Taylor has shared her experiences with other collaborative sites and contrasts her own approach with others in different areas. Some sites have focused on discharge prescriptions, prescription collection and delivery, and developing concordance, while others have carried out public campaigns on medicines wastage. There have been other approaches to problems of repeat prescribing, for example, with some centres hoping to provide surgeries with "repeat prescribing technicians" to train staff on site to help with backlogs. Mrs Taylor is now undertaking the second year of her project, pleased that changes are being integrated into normal practice. She is now working with the trust's prescribing team to roll the scheme out to the rest of the PCT. Further information on medicines management is available on the National Prescribing Centre website: www.npc.co.uk
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