Mary Green
Hospital Medicines Management Project Lead,
Nottingham City Hospital NHS Trust
Tel: 0115 969 1169 ext: 34287
Email: mgreen3@ncht.trent.nhs.uk
Summary:
Our overall goal of the programme is to optimise medicines management systems within the hospital service to ensure safe and informed outcomes of patient care, with a key focus on better and safer prescribing. The programme is driven by 5 supporting aims linked to Local Objectives, which are:
* Reduce delays in discharges due to prescriptions
* Increase the number of complete and recorded drug histories
* Increase communication of medication changes/stoppages to GPs and patients at discharge
* Reduce drug related errors
* Reduce turnaround time of work through the dispensary
Abstract:
The Hospital Medicines Management Collaborative programme is driven by 5 supporting aims:
* Helping patients and the hospital trust get the best from their medicines, identifying and addressing unmet pharmaceutical need, thereby delivering real improvements in health
* Optimising patient care in accordance with accepted local and national guidance, thus improving links between medicines management and clinical governance within the trust
* Improving communication systems for the dissemination of information on medicines management throughout the hospital trust and beyond
* Increasing multidisciplinary involvement in medicines management and making best use of the skills of the pharmacy team
* Developing medicines management approaches that increase the clinical and cost effective use of medicines, thereby increasing service efficiency and reducing waste whilst keeping the patients needs uppermost
PDSA cycles across acute and primary care have taken place with 3000 original bags.
Results of these trials once analysed and assessed led to the development and design of the Patient’s Medicines Bags (PMB) by working with NHS Innovations East Midlands. A second round of PMBs is currently taking place again across emergency and elective pathways. There are no further proposals to amend the PMB and an order for 85K bags has now been placed. Sponsorship for the cost of the 85K bags has also been secured, and implementation and spread plans drawn up. Service Level Agreement with East Midlands Ambulance Service has been amended to include the POMB. Guidelines for Healthcare professionals have been created for using the PMB. Ethnic laminates for East Midlands Ambulance crews have been created to accompany PMB use. Labels for PODs (patients own drugs) coming into hospital have been created with labels for Self Administration of medicines where safe and appropriate to do so created also. A Benefits Realisation is also expected to be produced for submission to the Strategic Health Authority by Christmas who will look to promoting the PMB as a “best practice” innovation. Patient Questionnaires, Random Encounters, Living Experiments, 1:1s, small group sessions and discussions with chronic disease management patients have also taken place.
Patients have been involved at all stages from initial trials through to redesign and implementation. They have engaged with the project lead at all levels via feedback from a variety of methodologies and techniques The bag has essentially been designed by patients for patients, they understand what it is for, why they should use it and when they should use it. Working from the outside in (working with patients to discuss design and build and how to maximise the potential of the medicines bag) has created an arena in which the patient plays an equal role in the healthcare partnership and engages with healthcare professionals resulting in potential improved communication, more and better understanding and safer prescribing and administering of medicines.
Patients bringing their medicines into hospital either through emergency or elective pathways has meant that healthcare professionals are now presented with a much fuller and improved quality medication history, thus helping reduce the guesswork for quick effective treatmentPDSAs have contributed to measurement for improvement, as has quantative data collected. Numbers of patients own medicines coming into hospital has increased with the drive on using patients medicines bags, both from ambulance admissions and at pre-operative elective clinics
Patient Experience: The feedback from patients was positive, especially those who had drug related problems e.g. experience of side effects, needing TTOs rapidly etc. Narrative was entered into with patients about their medication enabling the pick up of issues around medication prescribed but not used, experiences of side effects, concordance issues, and extra medication supplies at home. This improved patients issues clinically, reduced the need to supply medication on TTOs and improved turn-around times. Patient counselling on medication they were taking was also provided. This allowed them opportunity to ask more specific questions about their medication allowing for a more individual approach to counselling.
In order to part address the needs of a diverse population, ethnic information laminates have been produced for ambulance crews when engaging with patient’s whose first language is not English. Engagement is currently taking place with the Blind and Deaf Society’s as to how we can help the information flow to patients with regard to the patients medicines bags
Nottingham City Hospital is part of a collaborative of 45 trusts across the country. Work done has been demonstrated at workshops for the 45 trusts, plus other events. Teams from Nottingham City Hospital Trust have demonstrated work done in Pre-Op and with using the medicines bags as part of the Self Administration process for inpatients. We have also demonstrated how an Innovation has succeeded, by working with NHS Innovations. Private business engagement and sponsorship has also been achieved in order to get the project to successful conclusion. The PMB has locked in responsibilities by using diffusion techniques as opposed to dissemination techniques. In fact the PMB has sold itself. To-date 47 other trusts have requested sample packs of bags, guidelines for healthcare professionals, ethnic laminates, accompanying labels and instructions on how to implement in their trust.
As project lead I had to consider the local objectives and decide if there was any one thing that we could do within the timeline that would impact on all the local objectives. That turned out to be the provision of a patient’s medicines bag. It was exciting to research existing bags, try them out, change them, redesign our own, copyright it, produce guidelines and supporting information for other trusts to pick up and run with. Working with patients was inspirational, as was working with East Midlands Ambulance Service. NHS Innovations East Midlands provided the necessary skills for commercialisation. Finally setting something up that would leave a legacy behind - one which would become embedded in the patients subconscious was rewarding in the extreme! The PMB won the regional Health and Social Care Awards Patient Safety Award Midlands & East in July this year and is a national finalist at the awards in December, as well as being entered into the NHS Live event for 2005.
