Prescribing & Medicines
Management
Issue no 1, p13-14
January/February 2003
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Prescribing & Medicines
Management |
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Features |
Trading places to cut medicines waste
As a trading standards officer for 10 years, Chris Sutton worked closely with consumers and traders, using advice and persuasion to help businesses comply with consumer legislation and helping consumers avoid the rogue traders. Although always backed by the law he employed various methods to help traders think about new ways of working and rarely had to resort to the courts to force compliance. Married to pharmacist and prescribing adviser Claire Sutton, Chris was aware of parallels between his job and that of project facilitators in the newly emerging medicines management services. He saw a medicines management opportunity advertised in The Pharmaceutical Journal and, in autumn 2001, he decided to transfer his skills to this environment. He is now project facilitator for medicines management at Southampton City PCT which is a first wave pilot for the National Medicines Management Collaborative.
The prescribing team in Southampton City PCT is the envy of some areas, with 11 pharmacists directly employed by the trust as advisers working in surgeries — the equivalent of six full-time staff. The prescribing team is headed by Julia Bowey, the trust's pharmaceutical adviser, who is also a member of the PCT Executive Committee. Mr Sutton works with all the advisers, helping the whole team to optimise prescribing and to improve the experience and outcomes of medicine-taking for all patients. Within this goal, the PCT is hoping, in particular, to reduce medicines waste. In March last year, community pharmacists helped evaluate levels, and the reasons, of waste. When patients returned medicines to the pharmacy, staff collected what had been brought back and assessed why these drugs had not been used. A high level of natural waste was identified, especially with new prescriptions. As a result, the medicines management team invited GPs to rethink prescribing quantities of new or switched drugs. It also engaged with community pharmacists to relay such problems back to surgeries directly, where there were good channels of communication, or to the PCT itself. There was also a drive to amend patient medication records (PMRs) to note the return of unwanted drugs and to remove unwanted repeats from prescriptions. PMRs themselves are another focus for medicines management in Southampton. "We believe PMRs should be active rather than historical records," Mr Sutton said. "As more health professionals use PMRs, accurate recording is essential," he added. As in other areas, Southampton City PCT is hoping to improve synchronisation of orders. A travelling roadshow allows each surgery to involve all their staff in a practice meeting to discuss problems involving ordering and repeat prescribing. According to Mr Sutton, surgeries are often effective at pinpointing their problems.
Similar problems The team has found that many surgeries face similar problems and solutions that worked in other practices were often welcome and a number of successful action plans are now underway. These include educating patients on how best to reorder medicines. "Patients need to know that it can be difficult for surgeries to deal with scrappy pieces of paper and that reordering systems usually work well if the correct form is used," Mr Sutton said. The repeat prescribing roadshow is being rolled out to 40 practices over the next year and the PCT plans to carry out audits once the action plans and protocols are in place. Although formal results are yet to come, Mr Sutton said that there had certainly been considerable improvement in terms of the directions put on medicines, the synchronisation of prescriptions and the average number of items given to the over 65s. He was delighted that medicines management issues especially around medication reviews, had been included in the GP practice 2002-3 incentive scheme, along with incentives around targets from the NSF for Older People and audits of non-steroidal anti-inflammatory drugs and agents for dyspeptic disease. Speaking generally, Mr Sutton said that medicines management had allowed facilitators to go into surgeries, find out what issues were problematic and to develop solutions and ideas with those working there. Staff at each surgery sometimes thought that their problems were unique but, in fact, the prescribing team found similar themes occurring again and again. The medicines management team had established what did and did not work in the various centres, what ideas each were willing to take on and the methods each preferred to implement change. Official reporting on the project is due to end in August, but, according to Mr Sutton, the services had become part of the trust's everyday work and this was by no means the end of medicines management. Neither is Mr Sutton thinking of returning to a career in trading standards. Now established in health care provision, Mr Sutton remains a facilitator for medicines management and still works closely with the prescribing team. There is still a sizeable amount of work to roll out, specifically a trust procedure on the correct use for monitored dosage systems and improving the effective communication between primary and secondary care. However, he has moved from the prescribing team to the modernisation team concentrating on the interface between primary and secondary care and primarily supporting the PCT's models for reducing waiting lists. He also is involved in supporting the trust's community pharmacy clinical governance facilitator, where the main thrust at the moment is the collection and analysis of baseline data. |
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