The project had 2 main aims:
The project used the following outcomes in the evaluation:
Research shows the residential and care home sector as a significant contributor to medicines waste in the NHS in England, suggesting the systems and processes used in the sector account for around £50m of the estimated £300m annual total medicines waste. In order to promote safe and efficient medicines management, a technician led integrated collaborative approach was proposed to improve communication between service providers – care home, GP practice and dispensing pharmacy.
The Sheffield POL was established in April 2016 to improve repeat prescription processes in general practice and initially excluded care home ordering. See supporting information: Innovation for Prescription Ordering for Patients in Sheffield – summary. An aspiration was to develop the service to support care homes, offering the possibility of further medicines optimisation and reduction in waste. It was considered that the benefit of care home ordering via POL could be evaluated as part of this project.
The project was developed with reference to the National Institute for Health and Care Excellence; Guideline Managing Medicines in Care Homes (SC1 2014). Using local intelligence and expressions of interest 3 residential care homes were selected to be part of the project: control (CH1); technician only intervention (CH2); and technician intervention and ordering prescriptions using the POL (CH3). The GP service for all 3 care homes was provided by a dedicated GP practice under the local commissioned service for care homes.
The CCG Medicine Management Technician with a lead area in care homes was nominated to develop the project; to liaise with the other technicians, clinical practice pharmacists and MMSAs in the Medicines Management Team; and to liaise with all service providers. The technician interventions were carried out over a 3 month period; for CH3 this was prior to and during the initial period of ordering via the POL.
Care home residents:
Improved patient safety and medicines optimisation
Care home staff:
Efficient medicines management process within the home; improved communication with GP and dispensing pharmacy; reduction in time spent on ordering medicines.
General Practice:
GPs and supporting staff: reduction in work load, including phone calls to care home and GP tasks for monthly order, releasing time for other duties; reduction in prescribing costs and prescribed items assisting the practice to stay within their indicative budget.
NHS Sheffield CCG:
Reduction in prescribing costs and implementation of medicines optimisation for a vulnerable group of patients.
This project has highlighted the work that medicines management technicians and MMSAs can achieve, within an MDT, and supports the CCG's Medicines Optimisation in Care Homes Programme (MOCH).
For full details of outcomes achieved please see the full project pack: Innovation, Integration and Collaboration Medicines Ordering in Care Homes – summary.
Reduction in waste:
Waste was measured over the 3 months prior to the start of the intervention and 3 months after the intervention. CH3 demonstrated the greatest overall avoidable waste reduction, reduced from £530.65 to £32.75
There was an insignificant increase in avoidable waste in CH2 which suggests a greater impact of the technician working in association with POL.
Number of items prescribed:
Prescribing data year on year comparison, showed a reduction in items prescribed for CH3 over 3 months post technician interventions and ordering on POL. In month 3, there was a 34% reduction in items prescribed (from 417 to 275).
Interventions:
Feedback from CH3 and GP practice:
Care Home Manager:
…..The staff all cannot believe the difference this service has made. They no longer spend a high proportion of their day on the phone to the GP surgery as they did before, constantly chasing missing or needed prescriptions thus allowing them to complete their own tasks etc. The whole process goes more smoothly.
GP Practice Manager:
Before the POL team took over the prescription orders for our care home, the reception staff were inundated by requests, repeat requests and requests that just didn't make sense! This was causing stress for both our reception team as well as clinical….
…The receptionist learnt how monthly's worked and why they were done so far in advance.
In summary the receptionists have noticed a reduction in ad-hoc requests, queries and phone calls.
The support the lead technician has given the team has been invaluable.
Positive feedback was received from all parties. CH, GP practice and pharmacy identified the preferred way forward to be a revisit from the MM technicians to continue the intervention and review processes, along with continued communication and regular service provider meetings.
