Dorset CCG Medicines Management team are small compared to the rest of England. Currently, there are 3.1 locality pharmacists covering 86 practices in Dorset with a population of 770,000. To tackle the challenge of a small workforce and promote ICS (integrated care systems) we are moving away from individual practice visits this year. In line with other transformational work we are undertaking visits at locality level (4-8 practices). After contacting PresQIPP it became apparent that we were the first CCG to approach practice visits in this way. As a CCG we have identified areas of prescribing that require improvement throughout Dorset. The reasons for this could be financial but are primarily to improve patient safety. Sarah has then looked at the prescribing data for her locality and highlighted the main areas of concern to address with the practice prescribing leads. These areas come from both local and national priorities which are: Antibiotics, Benzodiazepines, Opioids, Dosulepin, Dorset CCG emollient formulary, Dorset CCG stoma ancillary formulary, Dorset CCG diabetic needle and blood glucose test strip formularies.
Sarah had come up with the idea of "Speed Dating on Drugs" individually whilst on a run. She wanted to find a way to engage the practice prescribing leads within her locality, to encourage them to work together and to provide a safe and constructive platform for all to share how they have tackled issues or issues they were struggling with. This also had to be undertaken in a structured way to ensure efficacy whilst sticking to a tight time frame (1.5 hours for 8 practices).
This new way of approaching problematic prescribing areas opened up communication channels and broke down barriers between practices. Instead of negativity surrounding missed prescribing targets, Speed Dating on Drugs gave this a positive spin: prescribers could learn from each other and share experiences. Learning from colleagues is a vital part of improving the service we provide to patients and this proved evident from the conversations that took place.
Later when each of these areas were discussed with the wider group and those who had discussed the topic during Speed Dating with Drugs were able to share with the wider group what they learnt in a focus group. This allowed for practical solutions and ideas to be discussed openly. Our team has often found that the Medicines Management team can provide guidance to prescribers but they are much more engaged when other colleagues are undertaking a similar process. Speed Dating on Drugs therefore paved the way for constructive discussion and solutions. It was felt that prescribers left enthused.
Ultimately, the patients. By encouraging best practice prescribing we can ensure safety. The big targets are antibiotic and opioid prescribing.
Antibiotics:
Prevent the unnecessary prescribing of antibiotics. Side effects from antibiotics can be unpleasant and if there is no clinical need for treatment then this just causes harm to patients. Overall we are looking to reduce prescribing to also tackle the ever growing problem of antibiotic resistance which is a global threat.
Opioids (for chronic non-cancer pain):
Ensuring that patients do not exceed the maximum daily dose of 120mg of morphine (or equivalent). There is no evidence that doses higher than this are clinically effective for greater pain relief and higher doses carry a higher risk of side effects and long term damage to health. There is also risk of abuse with opioids: addiction, diversion and street sales. Generally, there shouldn't be long term prescriptions for opioids for patients with non-cancer pain; if a patient required such pain relief then the root cause of the pain should be investigated and a better way to manage this be sought. This in the long term will improve patient outcomes. Pain management is complex but medication is a very small part of this management and attitudes towards this need to change.
The immediate achievement would be for Sarah finding a new and innovative way to engage prescribers with medicine issues. Speed Dating on Drugs was extremely well received and will be a technique we adopt in the wider CCG. Sarah should be recognised for her creativity and passion for improving local prescribing for better patient outcomes.
The long term achievements/ outcomes will be safer and more efficient prescribing and hopefully with better patient understanding.
