medicines management team update - buckinghamshire ccg€¦ · medicines optimisation 2018 and...

Clinical Chair Aylesbury Vale CCG: Dr Graham Jackson Clinical Chair Chiltern CCG: Dr Raj Bajwa

Accountable Officer: Lou Patten

Medicines Management Team Update



Medicines Optimisation in 2017

• Deprescribing/reducing variation

• Care homes

• Dietetics

• Improving Clinical outcomes – e.g. reducing stroke, Antibiotics

• Joint Formulary

• Responses to national consultations



Polypharmacy & Deprescribing • Medicines: stop, start or continue’ programme launched

• Polypharmacy and Deprescribing eLearning launched

• Toolkits to support primary care prescribers launched on: • Dosulepin • Identifying frailty • Medicines optimisation to reduce falls risk • Medicines optimisation to reduce risk of low HbA1c • Omega 3 • Reducing overprescribing for people with learning disabilities

(in progress)

• An EMIS (Egton Medical Information Systems) template making it easier for primary care prescribers to signpost to appropriate interventions to support frail older people live independently launched

• A polypharmacy and frailty stakeholder group was formed and strategic plan completed



Care homes

Medication review have been carried out for 353 residents

Reviews have resulted in

o 357 medicines being stopped for at least 50% of residents

o 41 interventions on medicines to reduce the risk of a fall

o 37 interventions on medicines that have high risk of causing admission

o 15 medication errors identified and resolved that have high or extreme harm risk

o Total savings from medicines stopped & admissions prevented is estimated as £52K

Systems and processes reviewed in 19 care homes with a total of 931 bed capacity (approx. 25% of Bucks care homes)

75% of care homes reviewed demonstrated quality improvement on at least 6 National Institute of Clinical Excellence (NICE) medicines standards

Implemented of the standard monthly ordering process and waste reduction guidance in 19 care homes had resulted in £49k savings



Care homes

Education and Training Sessions ; monthly webinars

and registrars training at Amersham community

hospital

Developed medicines management care homes

websites on both Chiltern and Aylesbury Vale CCG

website

CCG care homes medicines optimisation in

partnership with Bucks Quality in Care Team (QICT)

and Buckinghamshire Healthcare NHS Trust

Community Geriatrician was shorted listed for the

HJS awards 2015 & 2016

Care home work has led to having a Joint post for

Interface Pharmacist for Older people to develop a

seamless medicines optimisation service across the

ACS for older people ………….watch the space!

“I am looking forward for all future webinars. I found it

knowledgeable and helpful, and time and money saving

as no travel is required.” – Agata Met- Deputy Manager

at Swarthmore Residential Home

I just wanted to say thank you for the work you did at

Woodland Manor. The prescription ordering process is

much better now, and the number of inappropriate faxes

we receive have significantly reduced. Thank you again-

Dr Maria Easaw GP at The Allan Practice

The home was working on improving the service to people

with health conditions by engaging in the Medicines

Review in Care Homes project, supported by the AVCCG

and CCCG This involved a review of people's medicines by

a pharmacist and the GP. In doing so people were

protected from the risk of taking inappropriate medicines.

CQC Inspection report on Hamilton House published 21st

Feb 2017



Outcomes of improved diabetes training in care homes:

• 150 people are now competent to do blood glucose monitoring, recognise and treat

hypoglycaemia

• 45 Residential Homes sent 123 staff for training

• 25 Nursing Homes sent 71 staff for training

• 100% of staff that attended registered an increase in knowledge and confidence in managing

diabetes

• 100% of staff identified key change/s they plan to make in their practice

• Local Geriatrician now undertaking audits to identify patients at risk of hypoglycaemia

• De-prescribing toolkit developed to support GP’s and Practice Nurses to identify residents at

risk of hypoglycaemia, hospital admissions and cardiovascular events due to low HbA1c.



Prescribing Support Dietitian 2 national care home e-notes

systems advised re errors in

Malnutrition Universal Screening

Tool (MUST) calculation –

systems amended

Correct recognition =

improved treatment of malnutrition

Interventions

One of 1st CCGs to produce

guidance on blended diet for

paed tube feeding

Support for colleagues working with parents who have chosen this feeding method;

savings on prescribed tube

feeds

Joint Multidisciplinary Team working across CCGs, BHT

acute and community, Florence Nightingale Hospice,

care homes to produce Palliative Comfort Feeding

guidelines

Can help reduce unnecessary acute

admissions & inappropriate requests for tube feeding in last

year of life

Adoption of new direct

referral from care homes to BHT Dietitians across county

Reduction in inappropriate

referrals; reduced GP workload;

empowered care homes

Plan for joint working with Carers Bucks to share message that

low weight/ unplanned weight loss in old age

is malnutrition & treatment can improve health & quality of life

Improved recognition & treatment can

maintain independence &

avoid unnecessary acute admissions

Outcomes



Dietetic Assistant Practitioner - Malnutrition Universal Screening Tool (MUST) training

• MUST training delivered to 257 staff in 22 care homes

- Improved MUST completion - Residents body weight improved/ & nutrition care planning maintained



Senior Clinical Pharmacist Advisor

Provide clinical support to meet national targets in

Reduction of inappropriate antibiotic prescribing for Urinary Tract Infections (UTIs) in primary care

Significant reductions in

inappropriate use antibiotics & consistently meeting CCG

Quality premium targets

Key Interventions

Produce joint BHT /CCG formulary guidance on prescribing

Continence appliances in Bucks & supply of discharge packs for

patients requiring catheterisation

Facilitated clinically appropriate cost effective choices prescribed to

maximise clinical benefit whilst also containing prescribing costs across

the ACS. Improving the quality of care across boundaries through

introduction standardised catheter care pack ast point of discharge

Promotion of benefits & safe prescribing of oral anticoagulation (OAC) in pts with AF at

high stroke risk who are either receiving no or inadequate anticoagulation through

education & clinical support initiatives inc excellence in Atrial Fibrillation (AF) project

Overall reduction in number of high risk AF patients now not receiving OAC cover and corresponding reduction in no AF related strokes seen (ref Systolic Neural Network Accelerator on Programmable logic – SNAPP data). Majority of practices achieving OAC rates > 85% and in top the best performing CCGs

Outcomes



0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

AVCCG Chiltern CCG Bucks Total

Oral Anticoagulation % Uptake* in AF Pts With CHA2DS2VASc score ≥2 or ≥1 if Male

Jan-13

Sep-13

Mar-14

Aug-14

Feb-15

Aug-15

Jan-16

Jul-16

Feb-17

* Av 6 monthly figures taken from Grasp AF practice data



Joint Bucks Formulary and Guidelines

Maintaining Bucks joint formulary and clinical guidelines to deliver consistency to our population in terms of clinically effective use of medicines.



Chronic Obstructive Pulmonary Disease (COPD) guideline



Formulary and Guidelines Support work 2017

• Vitamin D in children guideline published

• Updated guideline on COPD

• Melatonin shared care protocol

• Updated guideline on Attention deficit hyperactivity disorder

(ADHD) and new treatments

• Treatment of psychoses and schizophrenia



Working across boundaries

• Sharing of all work with Sustainability and Transformation Programme (STP)/Thames Valley CCGs e.g. dietetic guidelines

• Agreeing joint Shared Care Protocols across Thames Valley initially in

Rheumatology • Joint commissioning meeting to optimise management of high cost

drugs outside of tariff • Supporting Public Health in re-procurement and implementation of

Substance Misuse service • Working with Oxford Health to align Joint formulary with Mental Health

trust



Prescribing Budget

• Both CCGs in best 12 CCG nationally in terms of Cost/standardised patient

• M8 forecast estimated underspend of >£200k

However…… • NSCO – national cost pressure due to drug shortages

are now estimated @ >£3m for Bucks CCGs which will forecast an overspend of approx. £1m



Medicines Optimisation 2018 and beyond • Joint posts across CCG/BHT e.g. Care of elderly

• Joint working with Fed Bucks e.g. Flu plan

• Medicines optimisation ACS board – new joint committee to oversee aligned projects and provide assurance that legal, financial and clinical outcomes are met

• Medicines optimisation stakeholder engagement event held to identify key system priorities; • Single point of access for medicines recourses

• Improved transfers of care

• Reduced waste



Waste Excess Medication Qty Cost

Nefopam Tab 390 £286.48

Seretide 250 Evo 4 £237.92

AgaMatrix Jazz Wave Strips (50) 9 £88.83

Zapain 30/500 Tablets 1000 £40.30

Aerochamber Plus 4 £19.44

Zamadol 100mg SR Caps 60 £14.47

Carbocistene Caps 95 £8.87

Domepridone 10mg Tab 213 £6.18

Eumovate 100mg Cream 1 £5.44

Gabapentin 100mg Cap 200 £4.00

Ferrous Fumurate 210mg 84 £3.50

Gabapentin 300mg Cap 89 £2.59

co-amoxiclav 500/125 tab 12 £1.13

Total £719.15



Summary of ACS projects

– Elderly care including dosette boxes

– Deprescribing

– Reducing variation

– Biosimilars

– Anti microbials

– Waste

– Generic meds 2ndry

– Transfer of Care

– Single point of access MO

– Potential Non FP10 supply (catheter, stoma wound care)

– Insulin pump management process

– Strategic place of home care



Thank

You!

Any Questions?

medicines management team update - buckinghamshire ccg€¦ · medicines optimisation 2018 and...

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