Moving the Green Medicines Bag from the Safety Agenda to QIPP Jane Hough (ESEE Specialist Pharmacy Services) Fiona Eccleston (PSF Project Manager) Ed England ( Ambulance Service)
Facts and figures 97% of all hospital patients take a medicine Poor communication at transition points is responsible for up to 50% of all medication errors & up to 20% of adverse drug reactions that occur in hospital 1 Avoidable medication errors costs the NHS in England 750million ( = 58million) 1 PSF Workstream: Reducing Needless Medications Errors was established in 2009 1 NPSA Patient Safety Observatory Safety in doses: medication safety incidents in the NHS
Aims of No Needless Medication Errors work-stream Safer admission to hospital and ensuring patient s medicines are reconciled within 24 hrs hours of admission Means of ensuring patients receive oral anticoagulation therapy within safe parameters Means of ensuring allergy status is recorded on patient prescription charts Pan-SHA introduction of Green Medicines Bags Means of evaluating and ensuring safer practice with concentrated injectables (The WHO High 5 campaign) Reducing risks around injectable preparation and administration in clinical areas (SCIP project) Means of preventing NSAID related incidents Reducing harm from omitted and delayed medicines in hospital Means of reducing admission to hospital due to insulin induced hypoglycaemia
Green Medicines Bag Initiative Supports NPSA/NICE guidance for Medicines Reconciliation by improving the safe transfer of patient s medicines between care settings Supports Care Quality Commission recommendations Managing patients medicines after discharge from hospital Unique collaboration across South Central NHS Trusts to rationalise and coordinate medicines management systems throughout the region
The Bag! Corporate logos; SHA & PSF Biodegradable material Advises patients what to put in bag 2 sizes Grip sealed Carrier handle Gusset & 2 punched holes Bagged into 100 s Initially = 90/1000 small & 125/1000 large + VAT
Why Green Bags? Improve patient safety & satisfaction in hospital by: reducing medicine related errors by increasing the number of completed medication histories; reducing prescribing errors on admission; reducing missed and delayed doses; reducing waste by reducing the resupply of medicines; facilitating self administration; improving discharge process; allows healthcare staff to understand how patients manage their medicines at home
Why Green Bags? Benefits to Primary Care Trusts, GPs, Community Pharmacists, Care homes & Ambulance service: improved communication at the transfer of care across interfaces; improved patient education around medication; improved patient adherence; cost savings through waste reduction; speeds up treatment & patient transfer
Benefits to patients: Why Green Bags? reducing confusion by allowing patients to maintain familiarity with own medicines; facilitates a quicker discharge; reduces hoarding of medicines at home.
Launch the Green Medicines Bag Planned First Phase launch for 1 st September 2010 Part of the No Needless Medication Error Work-stream Raised at SC QIPP meeting for Chief Pharmacist and Medicines Management Leads from all sectors Requested estimates of usage to allocate pump priming supply of bags Run a workshop to support those new to green bags and invigorate those already using and share experiences
Resources to support roll out Green Bag Toolkit - developed by East South East England Specialist Pharmacy Services Patient Safety Federation DVD Posters Leaflets to go in bags Briefings for Trust Managers & Clinical Staff Green Bags! P S S East & South East England Specialist Pharmacy Services East of England, London, & South East Coast Clinical Directorate Moving Medicines safely: Implementing a Green Bag Scheme A toolkit to support the implementation and evaluation of Green Bag Schemes within Medicines Management Services East and South East England Specialist Pharmacy Services
Launch the Green Bag workshops Meetings in July 10 - one in north and one in south Some trusts already using bags for discharges Some trusts already using bags for transfers between wards Trusts not using green bags at all Acute, Mental Health and Community Hospitals People who would co-ordinate implementing the change Made available tailored resources Requested Base-line audits carried out Action Plan of what each trust planned to do
QIPP: Potential savings? National agenda changing QIPP now the focus SC QIPP - 132m Medicines Management savings over 4 yearswaste/green bags to play part Using models from elsewhere: If medicines reconciliation is carried out for 80% of admissions = 3,000,000 Potential for 6.5 million if all patients admitted using a Green Medicines Bag.
Launching the SC Green Medicines Bag base-line audit May 2011 Wanted to calculate own potential savings Each trust to collect data On numbers of patients bringing in own medicines Were they in a green bag? Numbers of PODs (how many MDS) Were PODs used on the ward? Re- audit post introducing green bags
Audit in May 2011 across Care Area Number of Patients % bringing in PODs % PODs used on ward Green Bags brought in Medicine 1346 42.4% 66.7% 126 (22%) Surgery 991 47.4% 74% 68 (14.5%) Care of the Elderly 585 44.8% 75% 17 (6.5%)
Audit in May 2011 across SC Care Area Item saving ( per day) Daily savings ( ) Average LOS saving (3) Medicine 0.26 2.01 14.27 Surgery 0.32 2.51 10.29 Care of the Elderly 0.21 1.55 10.29
Calculating QIPP savings! Approximately 900,000 admissions a year in At least 40% of patients brought in PODs Approximately 70% of these were used on ward Conservative saving of 10 per day Equals QIPP saving of 2.52m per annum Plus further 1.26m pa from Medicines Reconciliation cost avoidance for 70% of these patients Total QIPP saving 3.78m Versus investment of 12k to buy the Green Medicines Bags to pump-prime the system
Waste Medicines Campaign Waste Medicines campaign to run across in Feb March 2012 Run by Dynamic usually focus on primary care Three main themes: Only order what you need Dispose of unwanted Medicines Safely Bring Medicines into hospital in your Green Medicines Bag Awaiting the outcomes of the campaign
Selling Green Bags Reduce Waste to GPs Keeps medicine supplies synchronised Avoids duplicate supplies (and potential double dosing especially if products look different) Reduces liklihood of medicines going out of date Opportunity to identify non-adherence whilst in hospital and either resolve or stop the medicine (helps target those who may benefit from a post discharge MUR!) Discharge medicines (repeat prescription?) only order what you need Need to prove secondary care can move medicines around the organisation and return to patient at discharge!
Redoing the POD and Green Bag Audit in 2012 Acute Trusts agreed to participate Similar type of data collected as in 2011 but wanted to know where Green Bag had come from (home, ambulance, A and E, admission ward, ward) Day of choice week of May 14 th or May 21 st Medical, Surgical and Care of Elderly Wards Data is still being returned Collating data now.. Headline information for Chief Pharmacists Each trust has tab for own data
Numbers and proportions of classification of Wycombe2012 Wycombe2011 Winchester & Eastleigh2012 Winchester & Eastleigh2011 Southern Health2012 Southern Health2011 Southampton2012 Southampton2011 Ridgeway2012 Ridgeway2011 Reading2012 Reading2011 Prospect Park2012 Prospect Park2011 Portsmouth2012 Portsmouth2011 Oxford Mental Health2012 Oxford Mental Health2011 Oxford Community Beds2012 Oxford Community Beds2011 ORH2012 ORH2011 NOC2012 NOC2011 Milton Keynes2012 Milton Keynes2011 IOW2012 IOW2011 Heatherwood & Wexham Park2012 Heatherwood & Wexham Park2011 County Hosp beds berks2012 County Hosp beds berks2011 Basingstoke2012 Basingstoke2011 -Number of Patients 50 Not on Meds 100 PTA 150 200 250 300 350 400 450 Number of Patients using MDS Number of Patients on Meds PTA but with no PODs Number of Patients with PODs
Oxford Data on PODs and Green Bags 600 500 400 300 200 100 Surg Med Elderly 0 Total number of items Patients with POD brought in Number of items used Number of patients Green bag brought in
Savings through using PODs 600.00 500.00 400.00 300.00 200.00 Surg Med Elderly 100.00 0.00 Total average actual savings per specialty Total average potential savings per specialty Average actual savings per day
What has worked well? SC has a history of working together PSF work-stream already in place Ambulance Service driving Commitment from Chief Pharmacists to purchase the SC Green Bag Linking Patient Safety with QIPP But need to keep revisiting and keep the interest high to sustain the scheme
Updating Tool Kit Green Bag Toolkit - developed by East South East England Specialist Pharmacy Services Initially about Implementing now want to include sustaining More on engaging with different groups of staff; patients and the public Want patient stories to make it real Adding section on sustaining a Green Medicines Bag scheme P S S East & South East England Specialist Pharmacy Services East of England, London, & South East Coast Clinical Directorate Moving Medicines safely: Implementing a Green Bag Scheme A toolkit to support the implementation and evaluation of Green Bag Schemes within Medicines Management Services East and South East England Specialist Pharmacy Services
Updating the Tool Kit Ambulance Staff Care Home Staff Clinical Commissioning Groups Community Hospitals Community Pharmacy Formal Carers GPs Hospital doctors Informal carers Mental Health Trusts Nurses acute and community Out of Hours Services Patients Prisons Public P S S East & South East England Specialist Pharmacy Services East of England, London, & South East Coast Clinical Directorate Moving Medicines safely: Implementing a Green Bag Scheme A toolkit to support the implementation and evaluation of Green Bag Schemes within Medicines Management Services East and South East England Specialist Pharmacy Services
Contact details Jane.Hough@ouh.nhs.uk Fiona.Ecclestone@iow.nhs.uk Ed.England@scas.nhs.uk