Medicines Use and Safety Annual Report -17 The first stop for professional medicines advice www.sps.nhs.uk MUS Annual Report -17 vs2 CL 1
The Medicines Use and Safety (MUS) Team are part of the NHS Specialist Pharmacy Service funded by NHS England. The Service underpins the safe, effective and efficient use of medicines across the country. After salary costs, medicines are the largest single investment that the NHS makes in patient care. Optimising the use of medicines and medicines related services is essential to achieve the best possible outcomes for patients and the public. About MUS The MUS Team are a small group of senior pharmacists with diverse expertise and knowledge across a number of specialist areas, such as Medicines Safety, Care of Older People, Community Health Services and Patient Group Directions. We deliver a wide range of events and resources, and are able to respond quickly to new and emerging medicines initiatives. The concept is simple, do once and share ; combining knowledge, joining up people, working as a team, spreading good practice and enthusiasm. Some of our outputs have a small but nevertheless important audience, such as medicines optimisation work in prisons. The MUS Team support national professional organisations outside pharmacy with certain medicines issues, working this year with the College of Occupational Therapists to provide guidance for their members on Patient Group Directions. In -17 we had an active year promoting medicines optimisation through the national media. This included team members commenting on medicines safety on Channel 4 News and the BBC Radio 4 Today programme. We also had some joint polypharmacy broadcasts with the Centre for Pharmacy Postgraduate Education, chaired by the TV presenter Martyn Lewis. What do we do? Co-ordinate best practice pharmacy networks to share innovation and facilitate implementation of national policy and guidance Develop resources and toolkits on current medicines issues where we have specialist expertise. We also lead collaborative multi-organisation audits and service evaluations to identify unwarranted variation and opportunities for development Present material at conferences, publish in journals and respond to national consultations on medicines. To further spread the word on improvements to pharmacy services Annual spend on medicines by the NHS exceeds 16 billion. Safe use of medicines and the best possible benefit for each individual patient are what underpin all the work of the MUS Team. www.sps.nhs.uk MUS Annual Report -17 vs2 CL 2
Highlights -17 Networks and Webinars We increased accessibility of our networks by running meetings in the North of England and introducing a webinar programme. New monthly webinars started in September and have proved very popular, with recordings also available after the event via the SPS website. The launch of the new SPS website in has also helped us reach a wider audience and identify our most useful articles and networks. With the increasing number of pharmacists working in primary care, our Clinical pharmacists in the community peer support networks gathered momentum in new geographies and the model is included in the NICE shared learning database as a means of supporting medication review. Medication Safety Officer Handbook The Medication Safety Officer (MSO) webinars (a joint programme with NHS Improvement) ran remarkably smoothly, very ably chaired by Yogini Jani, with plenty of input from the MSO network members. Yogini also authored one of our most popular resources, the MSO Handbook. This was published in September and offers basic help and support to get started as a new MSO, as well as ideas for how experienced MSOs can review and develop the role in their organisation. Patient Group Directions The new website analytics have highlighted the importance of the PGD materials to a wide audience. Two key items were Quality PGDs 7 steps to success and the update of To PGD or not to PGD? Following many queries, information on the use of PGDs in radiology services was produced in consultation with the Society & College of Radiographers. Medicines Optimisation in Atrial Fibrillation A combination of data for commissioners with a specific case study of anticoagulation in atrial fibrillation (AF) demonstrates how these are key tools for successful medicines optimisation. Our document uses nationally available data, such as that from the stroke audit programme, NHS RightCare and the Medicines Optimisation Dashboard, to build a picture of care and assess the quality of AF management for any locality. Building from this, there is a practical review protocol for patients on the AF register, which can be used to optimise anticoagulation in this patient group. www.sps.nhs.uk MUS Annual Report -17 vs2 CL 3
Core activities -17 Networks, Other Meetings and Webinars We continued this year with larger venues for many of our meetings in, along with providing some events in Leeds. However, the numbers attending have not increased greatly since 2015-16, although all national meetings were attended by delegates from every NHS Region. Feedback we have is that taking a day away from employing organisations is more and more difficult in terms of both logistics and finances. In contrast the new webinar programme took off swiftly, after the first trial run, all were full to the current capacity of 100 participants. Again these all have attendance from across the country. (Appendix 1A and 1B) Resources, Toolkits and Audits We published the results of two national audits in -17. One was on discharge information and subsequent medicines reconciliation in primary care. There was a lot of food for thought regarding both the quality of discharge letters and subsequent action in GP surgeries. The other audit of community pharmacies was linked to acute kidney injury and reported the provision of hydration advice to people with urinary tract infections. Both had exceptionally good uptake, with reports of more than 1,000 and 14,000 patients respectively, and they provide much needed insight into local variation and identification of good practice. We also produced nine new or updated resources, with subjects ranging from pain management in prisons to the quality of care in heart failure. (Appendix 2) Publications and Policy Many MUS publications this year were on polypharmacy, using the expertise of our two Consultant Pharmacists in Care of Older People. Both the national audits were presented at the British Pharmaceutical Conference in Birmingham, along with our evaluation of the Medicines Safety Officer network. Reviewing MUS materials we publish on the SPS website is an important task so we can maintain quality and relevance. There is also a bimonthly MUS Update sent to our networks and pharmacy leads. (Publications are listed in Appendix 3) Plans for 2017-18 Since the DH led review of the Specialist Pharmacy Service in 2014, a number of our staff have retired or moved on. We are now able to recruit to outstanding vacancies, and will be strengthening the team with experts from mental health, commissioning and acute care. To improve engagement in the North and Midlands, as well as circulating the MUS Update to all lead pharmacists, we plan to use the wider SPS workforce in these locations to highlight MUS projects and feedback ideas. Maintaining the monthly webinars and developing this format further to extend the webinar offering will be a priority. www.sps.nhs.uk MUS Annual Report -17 vs2 CL 4
This is the MUS Team. All are part-time with SPS, so our total work force this year was less than 4 WTE. Most also work in a Trust or CCG. We think it s a good model as it helps ensure our work is timely, relevant and grounded in practice. Sue Overton Team Administrator Nina Barnett Care of Older People Carina Livingstone Interim Director Lelly Oboh Care of Older People Yogini Jani MSO Network Tracy Rogers CHS Network Angela Bussey Patient Group Directions Helen Williams Cardiovascular Jane Hough MUS Network Denise Farmer Health & Justice Sandra Wolper CHS Network www.sps.nhs.uk MUS Annual Report -17 vs2 CL 5
Appendix 1A Network and other meetings -17 Link Date and Location April May June June July Leeds September September November Leeds November November December March 2017 Meeting Health and Justice Annual Pharmacy Network Meeting Medicines Use and Safety Network: Improving the way we inform patients; changes to Duty of Candour and Consent Community Health Services Network: Medicines Optimisation in CHS Clinical pharmacists in the community peer support group Medicines Use and Safety Network: Increasing Efficiency and Reducing Errors to support patient facing activities for HPTP Joint CHS MUS Network: Supporting patients with a Learning Disability and their Carers Clinical pharmacists in the community peer support group Patient Group Directions National Event: Development and/or implementation of PGDs for NHS services. Medicines Use and Safety Network: New ways of working transforming pharmacy services to support patients Older People Practitioner Day: Identification and management of pain and frailty Clinical pharmacists in the community peer support group Clinical pharmacists in the community peer support group Number attended (registered) Recommend to a colleague/ relevant to your needs 32 (46) 100% 4 85 (99) 100% 4 39 (45) 97% 4 16 (16) 100% 2 75 (77) 96% 4 46 (49) 100% 4 21 (23) 100% 2 21 (27) 100% 4 65 (74) 100% 4 85 (87) 100% 4 20 (24) 100% 2 19 (25) 100% 2 Attendance from all NHS regions (4) www.sps.nhs.uk MUS Annual Report -17 vs2 CL 6
Appendix 1B Webinars -17 Link Date & Host Topic Number registered September Jane Hough October Helen Williams November What the SPS Medicines Use and Safety Team can do for you Heart failure and Medicines Optimisation (joint event with PrescQIPP) Medicines Optimisation in Atrial Fibrillation Delegate rating Recommend to a colleague 33 62% n/a 4 n/a n/a n/a n/a 100 100% 100% 4 Attendance from all NHS regions (4) Alison Warren December Lelly Oboh January 2017 Angela Bussey February 2017 Yogini Jani March 2017 Lelly Oboh Patient centred approach to optimise medicines use for older people living with frailty PGD update established users Medicines safety priorities for 2017 Case studies of medicines optimisation in frailty n/a n/a n/a 4 102 n/a n/a 4 109 97% 100% 4 97 98% 100% 4 www.sps.nhs.uk MUS Annual Report -17 vs2 CL 7
Appendix 2 Resources and audits published in -17 Date July Title Heart Failure: Using data to assess the quality of care in heart failure Link Evidence base Guidance/ checklist How to implement Practice examples Audit tools and reports July Quality PGDs 7 steps to success Link July To PGD or not to PGD (Update) Link Aug Medicines Reconciliation: Audit of transfer from secondary to primary care Link Aug Questions about electronic systems and PGDs Link Sept Medication Safety Officer Handbook Link Sept Pain management formulary for prisons: Examples from practice Link Oct Atrial Fibrillation : Medicines Optimisation in AF Link Jan 2017 Acute kidney injury: Community pharmacy hydration audit Link Jan 2017 PGDs for administration of Contrast Media in Radiology Services Link Jan 2017 The Rough Guide to Community Health Services (Update) Link www.sps.nhs.uk MUS Annual Report -17 vs2 CL 8
Appendix 3 Publications Barnett N & Jubraj B A themed journal issue on deprescribing. Eur J Hosp Pharm 2017;24:1-2 doi:10.1136/ejhpharm--001118 Link Barnett N and Kelly O. Deprescribing: is the law on your side? Eur J Hosp Pharm 2017;24:21-25 doi:10 1136/ ejhpharm--000949 Link Barnett N and Parmar P. How to tailor medication formulations for patients with dysphagia. The Pharmaceutical Journal 297:7892 p 106-108 Link Barnett N and Sokol D Why pharmacists need to re-evaluate what information they provide to patients. Pharmaceutical Journal, Vol 298, No 7897, p 28-30 online DOI: 10.1211/PJ.2017.20202226 Link Barnett N, Patel A & Kalsi D Contribution Of A Pharmacist To The Rapid Response Service In Prevention Of Medicines-related Admissions Journal of Pharmacy Management 2017 33 (1) p 5-12 Link Barnett N. Chapter on Pharmacocultural issues and Chapter on Patient Consultation. In Gray SH, Wright J, Lynn B et al (eds). Clinical Pharmacy Pocket Companion Second edition published 2nd Dec 2015 - Link Barnett NL Improving pharmacy consultations for older people with disabilities. Journal of Medicines Optimisation :2 (4) p 72-76 Link Barnett NL, Oboh L Smith K. Patient-centred management of polypharmacy: a process for practice Eur J Hosp Pharm ; 23: 113-117 Bhandal S, Barnett N & Clarkson K. Development of an aphasia-friendly warfarin consultation tool for patients after stroke. Br J Neuroscience Nursing 12:3 p112-116 Jani Y. Learning from medicine related safety incidents. Prescriber, Oct 2015, vol./is. 26/19(22-26) Jubraj B, Barnett NL, Grimes L et al. Why we should understand the patient experience: clinical empathy and medicines optimisation Int J Pharm Pract. doi:10.1111/ijpp.12268 Link Oboh L & Qadir MS. Deprescribing and managing polypharmacy in frail older people: a patientcentred approach in the real world Eur J Hosp Pharm 2017;24:58-62 Link Oboh L, Peer Support Meetings for Pharmacists Undertaking Medication Reviews for Older People in Care Homes and Domiciliary Settings, NICE Guidance Link Oboh L. Communication during transfer of care of older people. Pharm J 296; 7889 May 300-303 Link Poots AJ Jubraj B and Barnett N. Education around deprescribing: spread and embed the story so far. Eur J Hosp Pharm January 2017 Vol 24 No 1 p7-9 Link Rogers T, Livingstone C, Nicholls J & Wolper S. A collaborative evaluation of pharmacy interventions in the care of inpatients in community hospitals Eur J Hosp Pharm doi:10.1136/ejhpharm-2015-000848 Link Shah C, Barnett N. Medicines Reconciliation: A patient safety priority. Prescriber 15 Nov 2015: 23-6 Shah C, Ishmael N, Wright J. How nurses contribute to medicines reconciliation. Nurse Management. 2015; 22(2): 18-22 www.sps.nhs.uk MUS Annual Report -17 vs2 CL 9
NHS Specialist Pharmacy Service www.sps.nhs.uk www.sps.nhs.uk MUS Annual Report -17 vs2 CL 10