Prescribing & Medicines
Management
Issue no 1, p11-13
January/February 2003
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Prescribing & Medicines
Management |
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Features |
Health and social services hitch themselves to the same star
As we are all well aware, the NSF for Older People introduced the nation-wide standard of conducting annual medication reviews for everyone over 75 years old, or six-monthly reviews for those taking at least four regular medicines.1 There is a wealth of evidence to support this standard, and we all recognise how beneficial such a service would be for our elderly population. The challenge is trying to meet it. No clear guidelines Previously, there have been no clear guidelines available to work from, with PCTs often leaving the issue of medication reviews down to individual practices. In North Eastern Derbyshire (NED) PCT, this has resulted in varying levels of review, with some being conducted on a superficial and opportunistic basis. In addition, recording when medication reviews are conducted is left up to individual practices, so audit is practically impossible. The publication of the NSF for Older People and the establishment of an MMS Collaborative site in this area, gave the perfect opportunity to address the issue of medication reviews for the over 75s. Teaming up with social services The medication assessment tool project began in early 2002, when the PCT's medicines management team and MMS Collaborative began developing a form to help guide medication reviews. By coincidence, one of the people involved was discussing the work with a changing workforce programme (CWP) colleague, who mentioned that they were also working on medication usage with the elderly. It turned out that Derbyshire social services were involved in a CWP pilot project, investigating how their care staff could help clients to take their medicines. In the spirit of partnership working, both parties came together to work on the project, using each other's expertise and resources, and reducing duplication. This is an excellent example of how great things often come by chance! Key element for both groups The key element linking the work of both groups is the need to determine what, if any, practical issues patients have with using their medicines. For example, does the patient have any difficulties taking the tops off bottles? The health sector needs this information as a part of a medication review to ensure patients are using their medicines to best effect. Social services need this information in order to determine what practical assistance they should offer to clients to help with medicines usage. The same information is being collected, but for different reasons. Development of the tool The development of the tool was overseen by a multi-agency steering group, with representation from both social services and the health sector. Many other groups and our neighbouring PCTs are also involved now, although the health sector lead remains NED PCT.
Due to the size of the project two other working groups were formed that feed into the steering group. One looks at the development of the forms themselves and the other looks at how the tool can be implemented. The main testing teams are the MMS Collaborative practices and the CWP pilot sites, as part of an extensive consultation network. The overall aims of the project can be found in panel 1 (p11). So what is the tool? The medication assessment tool that has been developed consists of two forms, the medication risk assessment form and the clinical assessment form. Their development has been influenced by the NSF for Older People, the Grampian2 model of good practice, and more recently, the Room for Review3 medication review guide. Medication risk assessment form The purpose of this form is to collect information on patients' use of medicines, focusing specifically on practical issues. It is intended that this form will be used across a variety of settings, including social services, with the information shared between different parties. From a social services perspective, the information from this form will be used to write up a medication care plan, from which home helps will work. From the health sector's perspective, it will form part of a full medication review. Due to the generic nature of this form, the assessor may come from a variety of different professional backgrounds, including nursing, pharmacy or social services. The form will need to be completed with the patient, with the assessor being responsible for taking action to deal with any outcomes and sharing the information with other relevant parties. Clinical assessment form The purpose of this form is to collect information on the clinical issues involved with medicines usage. It will be used within primary care and the hospital service, and will also form part of regular medication reviews. Due to the clinical nature of this form, it is currently necessary for the assessor to be a GP or pharmacist, with the potential for other professional groups to receive appropriate training in the future (eg, nurses and pharmacy technicians). Again, this form is to be completed with the patient, though it is possible for some of the questions to be answered using the patient's notes alone. Currently, regardless of who the assessor is, it will be the patient's GP who ultimately authorises any resulting changes. Medication review: current position Both forms have undergone extensive testing, using the change implementation cycle of "plan, do, study, act" (PDSA) to refine them, and are now at the final draft stage. They are currently in a paper format, although electronic templates are being developed for use within general practice, which will include Read coding protocols. Work is currently underway to determine the pathways and protocols for implementing the tool, including methods for sharing information between health sector agencies and social services. Once the implementation package has been developed, it will undergo piloting before final roll-out. A guidance and training package will also be developed to complement the tool and assist with roll-out. The eventual plan is for the Medication Risk Assessment form to be adopted by Derbyshire Social Services, with adoption of both forms across NED PCT. This work has been done in collaboration with other PCTs in North and South Derbyshire, who may also choose to adopt the system. It is hoped that the draft implementation plan will be available for piloting by mid-2003, with roll-out within NED PCT starting by the end of 2003. Medication review: ultimate goal It is envisaged that this tool will become part of the single assessment process, and will result in better partnership working and communication between health and social services, more empowered patients, and strengthened safety and quality of medicines usage for our patients.
Contacts For further information please contact: 1. Peta Dodsworth 2. Alison Tongue 3. Sue Knowles |
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