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Collaborative awards presented at gala

For the past five years the National Prescribing Centre (NPC) has run various medicines management collaborative programmes involving teams in primary and secondary care and community pharmacy.

To celebrate the successes of the participating teams, and 10 years of the NPC, it organised a gala awards ceremony at which two teams presented their projects in five categories. Richard Seal, director of medicines management at the NPC, was master of ceremonies, and winners and runners-up were presented with their awards by Jeanette Howe, deputy chief pharmacist at the Department of Health, England. The day was rounded off by an address from Heinz Wolff, emeritus professor of bioengineering at Brunel University.

Mr Seal started the day’s proceedings by saying that many people had been involved in the collaboratives: 146 primary care trusts, 44 acute hospital and mental health trusts, 28 community pharmacies and 25 health community teams. They had all contributed to “making medicines management everybody’s business.”

Care at the interface

The first award went to Coventry Teaching PCT in the category of “increasing patient care at the interface”.

Mark Galloway, head of medicines management at the PCT, said one of the team’s key aims had been to use community pharmacists’ skills to improve prescribing efficiency and, to that end, it had developed the Prescription Review and Intervention Scheme with Education (PRISE) project.

Pharmacists were paid to highlight to prescribers potential dose optimisations, excessive repeat prescribing and the potential for brand to generic switches. An analysis revealed that for every £1 spent on fees for pharmacists, £3 savings were made to the prescribing budget (from over 11,000 interventions, £112,000 cost-savings were made with payments of £28,000 made to pharmacists).

Oxford Radcliffe Hospitals NHS Trust was the runner-up in this category with a project to improve the efficiency of the out of hours pharmacy service.

Increasing safety and reducing risk

In the second category, “increasing patient safety and reducing risk” the award went to East Kent Coastal PCT.

Heather Lucas, the PCT’s pharmaceutical adviser, described the medicines support service designed to assist patients — identified by health care professionals or those working in social services — who were having difficulty taking their medicines. Patients were assessed by pharmacy technicians, with back-up provided by a clinical medication review undertaken by a prescribing adviser.

Half the referrals came from social services and it became apparent that, for the scheme to work effectively, care agency staff had to be trained how to administer medicines safely and to know where their responsibilities lay. The successful implementation of the scheme has resulted in less drug wastage and fewer hospital admissions.

South Staffordshire Healthcare NHS Foundation Trust was the runner-up team for improving the reconciliation of medicines in a mental health trust. This project — although in the third wave of the collaborative — had been the first opportunity for mental health services to be involved.

Efficiency and waste

The third award was picked up by Ashford PCT in the category “increasing efficiency and reducing waste.” The basis for the project was so simple and so reproducible every PCT and health board in the UK should take note.

Sandra Swinerd, lead medicines management technician at the PCT, revealed that from studying ePACT data it emerged that the trust was spending £250,000 per year on blood glucose testing strips — a sum larger than that being spent on oral glycaemic drugs.

An audit carried out at several practices showed that patients were ordering many more strips than they required. (Patients controlling their diabetes with oral glycaemic drugs need not check their blood glucose more than twice a week and those controlling their condition through diet need not test their blood glucose at all.)

After discussion with patients test strip usage has dropped and community pharmacists are to participate further in their care by discussing blood glucose test strip usage as part of the medicines review process.

University Hospitals of Leicester NHS Trust was the runner-up with a project that involved employing medicines management assistants to improve medicines housekeeping.

Patient involvement

Calderdale and Huddersfield NHS Foundation Trust — rated as excellent in the Healthcare Commission’s medicines management health check — won the “patient involvement” category.

The award recognised the trust’s efforts to increase patient safety and reduce risk through the self-administration of medicines.

Karen Guy, one of only a handful of nurses who work in a UK pharmacy department, described the benefits to staff as well as patients through the introduction of self-administration. The time spent, for example, administering medicines on the medicine round dropped from just over four hours in every 24 hours to less than two hours.

Patients’ knowledge about their medicines, why they have been prescribed them, the dose, course and possible side effects improved. She explained that the system enabled patients to “practise” taking their medicines before they are discharged and so enables hospital staff to help patients and their carers cope with more complication medication regimens.

The runner-up team from Hinchinbrooke Healthcare NHS Trust looked at improving access to medicines in hospitals by Parkinson’s disease patients.

Improving access to medicines

In the final category “improving access to medicines”, the winning team from Guildford and Waverley PCT was represented by Fay Boyett, medicines management facilitator, and Fiona Harris, chief pharmacist, who described the COUNT project.

COUNT stands for Confused over how much medicine to take and when to take it; Over ordering medicines — too many packets at home; Unable to open packaging — unable to unscrew the lids on bottles or open the foil packs; Not taking medicine — forgetting, or choosing not to take medicine; and taking Too many or too few journeys to fetch medicines.

Using information gleaned from this, the team has been able to focus on ways to help old people to take their medicines.

The team has developed a calendar for 2007 which includes a section describing various compliance aids and, following some market testing with people in a day centre, the testers — mostly women in their 80s and 90s — decided that a magnifying glass and a pill popper would be the two most useful aids in helping them take their medicines.

The runner-up award in this category went to Central Cornwall PCT with a community pharmacy-based asthma project.