CQC Assessment at The Vesey




Medicines optimisation

Medicines optimisation

Safety is a priority for everyone and leaders embed a culture of openness and collaboration. People are always safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. Their liberty is protected where this is in their best interests and in line with legislation.

Where people raise concerns about safety and ideas to improve, the primary response is to learn and improve continuously. There is strong awareness of the areas with the greatest safety risks. Solutions to risks are developed collaboratively. Services are planned and organised with people and communities in a way that improves their safety across their care journeys. People are supported to make choices that balance risks of harm with positive choices about their lives. Leaders ensure there are enough skilled people to deliver safe care that promotes choice, control and individual wellbeing.

Medicines optimisation

Our Evidence:

Medicines optimisation

Problems with medicine use

The following problems have been identified with how medicines are prescribed and used in the community setting.

The key areas to consider when assessing an individual patient and their use of medicine include the following.

  1. Are patients actually taking their medication?
  2. A small percentage (16%) of patients who start a new medicine take it as intended, have no problems, and receive all the information they need.
  3. Almost one third of patients are not taking their medicines as they should after 10 days of starting a medicine, 55% do not realise that they are not taking their medication correctly, and 45% have stopped.
  4. How well are medicines used?
  5. Medication errors are common; over two thirds of residents in a study in a care home were found to be exposed to one or more medication errors.
  6. The National Patient Safety Agency (now part of NHS England) reported over half a million medication errors between 2005 and 2010, 16% of which involved actual patient harm.
  7. In 2010, it was estimated that 1.7 million serious prescribing errors occurred in general practice.
  8. Are we getting best value from prescribing?
  9. About £300 million per annum of medicines are wasted in primary care of which £150 million is avoidable.
  10. It is estimated that at least 6% of emergency re-admissions are due to entirely avoidable adverse reactions to medicines.
  11. Are patients receiving the right medicines for them?
  12. The NHS Atlas of variation (2011) identifies variations in the prescribing of hypnotics across England, a group of drugs that become less effective over time and may cause psychological dependence.

This evidence demonstrates that medicines are not prescribed and used to best effect, leading to much wastage and poor clinical care and outcomes for patients.

Medicines optimisation

The Royal Pharmaceutical Society, together with NHS England, the Royal College of General Practitioners, the Royal College of Nursing, the Association of the British Pharmaceutical Industry and Academy of Royal Colleges, has published a good practice guide for healthcare professionals in England on how to help patients make the most of their medicines or “medicines optimisation”.

Medicines optimisation is about ensuring that patients receive the correct medication at the right time, and this involves a holistic approach by healthcare professionals working in partnership with patients. It is also about examining how patients use medicines over time, and this may include stopping some medicines, starting others, as well as considering lifestyle changes and other nonmedical therapies to reduce the need for medication.

The aim of the guidance is to encourage professionals to make medicines optimisation part of routine clinical practice.

Four guiding principles of medicines optimisation

The following four guiding principles have been identified to help patients and professionals make the best use of medicines.

  1. Understanding the patient's experience.
  2. In order to improve the outcomes from medicine, it is necessary to be clear about the patient's understanding of their medication through continuing dialogue, as this may change over time, even when the medication remains the same. This is particularly important, for example, in patients with mental health conditions where their lifestyle is at odds with the regularity of timing of their medication and they may miss taking their medicine.
  3. It is vital that patients feel able to discuss their beliefs, preferences and experiences about taking medication and a shared understanding is achieved with the healthcare professional.
  4. Select medication that is based on the evidence.
  5. Selecting the medicines that have been assessed as clinically and cost effective leads to better outcomes for patients. Using guidance published by the National Institute for Health and Care Excellence (NICE) and locally agreed formularies enhances the use of evidence-based medicines and reduces the chances of using treatments that have limited clinical effect.
  6. Medicine use should be as safe as possible.
  7. This underlies the principle of patient safety in “doing no harm” and covers unwanted effects and interactions, safe processes and systems and good communication between different healthcare professionals. The aim here is to reduce the incidence of avoidable harm from medicines, encourage patients to ask about their medication, have systems for safe disposal of drugs in community pharmacies, identify and report potential side effects and reduce admissions and re-admissions to hospital due to incorrect medication usage.
  8. Ensure that medicines optimisation is part of routine practice.
  9. The aim here is to embed the practice of medicines optimisation as part of routine clinical practice between healthcare professionals and patients. This will make it easier for patients to discuss their medication with healthcare professionals and receive a consistent message due to better team liaison, will reduce medicines wastage, and will enable the NHS to achieve better value for money.

Examples of medicines optimisation

The Royal Pharmaceutical Society has published examples of medicines optimisation applied to different conditions including cardiovascular disease, diabetes and schizophrenia using the four guiding principles outlined above.

Below is the example for managing patients with asthma.

  1. Understanding the patient's experience.
  2. The areas to be considered include:
  3. how asthma affects the daily activities, including sleep patterns, of the patient
  4. how the patient uses their inhaler including a demonstration of their technique
  5. having a personalised asthma action plan with instructions on adjustment of their therapy according to their symptoms or peak flow readings
  6. what beliefs and feelings the patient has about taking or not taking the medication.
  7. Select medication that is based on the evidence.
  8. The areas to consider include:
  9. ensuring that the patient is using the inhaler and/or device correctly
  10. ensuring that the patient is aware how to use their personalised asthma action plan in response to their symptoms or peak flow readings
  11. referring to the British Thoracic Society guidelines to the stepped approach to steroids (inhaler and/or oral) if the asthma worsens.
  12. Medicines use should be as safe as possible.
  13. This includes:
  14. ensuring that there is the correct use of medication, for example avoiding excessive use of reliever medication and under use of regular therapy
  15. a discussion with the patient about avoiding or dealing with side effects
  16. ensuring that the personalised asthma action plan is kept up to date and includes contact details that can be used if their condition deteriorates.
  17. Ensure that medicines optimisation is part of routine practice.
  18. This includes:
  19. discussing with the patient their peak flow readings and how this can support better management of their asthma using their personalised asthma action plan
  20. checking that the patient knows what to do if they have an asthma attack
  21. having regular asthma reviews with their doctor or asthma nurse
  22. giving the patient a steroid card if they are on high doses of steroids.

Reflecting and improving on practice

It is important that practitioners reflect on their prescribing practice and below are some key questions that can be asked to help the health professional to focus on this.

When discussing medication use, the practitioner should also explain the need to come back to an identified health professional if the patient:

Similarly, patients should be encouraged to ask health professionals about their medication in order to help them improve their medicines usage. The types of questions that could be asked include the following.

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Relevant review:

Medicines optimisation
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