Improving Prescribing for the Elderly (ImPE) My Medication Passport ImPE ICHT Ann Jacklin, Hayley Bray, Fran Husson On behalf of the ImPE Supergroup for Northwest London
Agenda Introduction to team Background to ImPE The Imperial Experience The NWL Supergroup My Medication Passport Working together in London
The ImPE Aim Aim: To reduce the burden of adverse drug reactions and consequent health problems in the elderly. Objectives: To develop and use a medication review system based on the evidence based tool ( STOPP Screening Tool of Older Persons potentially inappropriate Prescriptions) for use with elderly patients across all sectors of care, using quality improvement methods. To increase knowledge and confidence amongst staff in carrying out medication review through awareness and education. To provide patients with better information about their medicines
The Imperial Experience The Improving Prescribing for the Elderly (ImPE) project was funded by the National Institute for Health Research Collaboration for Leadership and Applied Health Research and Care (NIHR CLAHRC) for northwest London, in April 2010. ImPE form developed and review method piloted. Admission units patients over 70 on 4 or more medicines. Nursing Home and GP practice also involved. NWL Supergroup formed 2012 with extension to Chelsea and Westminster and The Hillingdon Hospital.
ImpE Spread and Dissemination GP Medical Centre Nursing Home ICHT/CLCH Falls Clinic Pharmacy/ Acute Admissions The Hillingdon Hospital Pharmacy/ Acute Admissions Chelsea & Westminster Hospital NWL CLAHRC Supergroup ICHT Pharmacy/Acute Admissions Hammersmith Hospital ICHT Pharmacy/ Acute Admissions Imperial College Healthcare 2010 2011 2012 2013 Time
ICHT Results Top 3 potentially inappropriate medicines Top 3 potential ADRs identified ICHNT - Acute Medical Wards Of the 1177 patients reviewed 72% * on Antihypertensives 43% on Diuretics 39% on Warfarin/NSAIDS/ Antiplatelets 69% indicated one or more potential ADR Falls Clinic Of the 52 patients reviewed 52% on Antihypertensives 29% on Opiates 21% on Other 96% indicated one or more potential ADR Nursing Care Home Of the 75 patients reviewed 87% on Other 45% on Antihypertensives 45% on Warfarin/ NSAIDS/ Antiplatelets 95% indicated one or more potential ADR GP Centre Of the 122 patients reviewed (June Dec 2012) 71%) on Antihypertensives 56% on Other 30% on Warfarin/NSAIDS/ Antiplatelets 63% indicated one or more potential ADR Total Cumulative Results Of the 1426 patients reviewed 69% on Antihypertensives 40% on Diuretics 39% on Warfarin/ NSAIDS/ Antiplatelets 71% indicated one or more potential ADR Changes made to medication 53% 37% 69% 35% 52%
Outputs and Outcomes Over 1400 ICHT patients over 70 across NWL have had medication reviews undertaken using the ImPE tool On average across community and acute sites, on review using the ImPE tool, 52% of those patients had changes to their medication, with a number of these changes including medicines being stopped or doses reduced Upon admission to the acute medical wards across all three ICHT sites reviews routinely take place in all acute sites as part of regular working practice Work is being undertaken to ensure the sustainability of the review process including potential for development of an app Future work involves exploring outcomes such as reduction in hospital admissions & GP attendances, disseminating work wider across Northwest London and identifying potential cost savings of stopping drugs.
Patient and Public Involvement My Medication Passport From working with a focus group and using quality improvement methodology to iteratively develop, patients developed the idea of a medication passport, to help the communication of medicine changes across sectors of care In turn, this would empower patients and make them key stakeholders in decision making My Medication Passport is now widely used across the trust, and plans to ensure the availability of the passport to all healthcare providers across Northwest London is in progress 5000 passports issued to date, 1500 newly distributed across the trust We are also undertaking evaluation to understand the impact of the passport on patient care and the service Patients continue to be champions to the project and independently promote the benefits in the trust.
Earlier this year, my wife underwent surgery. During her stay, I picked up a small booklet called a 'MEDS PASSPORT' that was being freely distributed to patients and visitors alike in the area adjacent to main reception. We both thought the concept was brilliant as we travel quite a lot and my wife is on a wide range of medication at all times. Having something handy like this would be a life-saver if we found ourselves far from home and needing urgent medication. Patient feedback, November 2012
The next steps: My Medication Passport My Medication Passport has been adopted by the ImPE Supergroup and CLAHRC NWL to ensure the availability of the passport for all NHS providers in the NWL area. External sources of funding sought 1. Passport more widely available across Northwest London January June 2013 Evaluation as part of program Project led by the ImPE Supergroup, on behalf of the CLAHRC for NWL and working closely with industry partners. 2. Plan for passport to be made available Nationally Based on NWL experience
Communication Industry stakeholders NW London consultation parties (incl integrated care) Patient groups Other healthcare professionals Mental health Trust Pharmacists MMP appropriate patients in NW London General public Community Pharmacists GP and practice nurses Acute Pharmacists
Evaluation A number of evaluation avenues are being developed including: Survey to explore whether the mechanism for making the passport available is acceptable? Formal qualitative research into patient views and beliefs Pragmatic patient and stakeholder research to understand how the passport is used and by whom It is hoped that the current evaluation program will inform further research into the wider impact of the passports on patients, patient care and the wider health economy
How can you help? ImPE Review Tell us what you think of ImPE Tell us how it compares to what you are doing Think about whether we can join it all together My Medication Passport Tell us what you think of the passport Tell us how it compares to what you are doing Tell us what you think of our plan