Pharmaceutical Clinical Effectiveness programme in Northern Ireland
On 15 November 2012 Pharmacy Management, in collaboration with the Department of Health, hosted its inaugural National Forum in London to allow healthcare professionals the opportunity to hear first-hand from the people setting the pace and the direction in the NHS. Professor Michael Scott, Head of Pharmacy and Medicines Management, Northern Health and Social Care Trust described during one of the satellite sessions how this – with the help of STEPSelect – has been achieved.
Overview:
The expenditure on medicines in the health service is of the order of 12% of the budget. It is therefore essential that optimal benefit is obtained for such resource utilisation. In addition there is significant inappropriate medicines use which has been estimated to cost in the region of $100 billion per year in the USA. Further it is estimated that 10% of admissions to hospital are related to adverse drug reactions of which half are preventable. Thus in order to address these issues the Pharmaceutical Clinical Effectiveness programme (PCE) was introduced in Northern Ireland.
Situation:
In Northern Ireland the expenditure in medicine across both primary and secondary care was in excess of £500 million per annum and increasing rapidly. The impact of inappropriate medicines use was resulting in excess bed days to the value of £42 million per annum due to adverse drug events and most importantly sub optimal patient care with resultant morbidity and mortality.
Task:
The task was therefore to put in place a range of initiatives that would address all aspects of the medicines management process as defined by the Audit Commission i.e. ‘the entire way that medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contributions that medicines make to producing informed and desired outcomes of patient care’. The programme was based on the premise that safety and quality would drive health gain and economy over the short to medium term.
Action:
Initially funding was obtained (2000) to put in place an integrated medicines management programme in one hospital Trust with comprehensive assessment of all outputs. Subsequently a number of further actions were undertaken over the periods 2005-2008 and 2008-2011 to continue with the improvements which have now been extended and with additional actions to 2015.These projects have also been supported by the development and use of new technologies such as EPICS for pharmacist interventions and STEPSelect for robust objectified procurement.
Results:
The PCE programme has resulted in significant improvements in patient care through better use of medicines, improved medicines reconciliation, faster discharge , reduced length of stay in hospital, reduced readmission rates, decreased morbidity and mortality , improved medicines administration error rates, better use of nursing and medical staff time, improved generic prescribing rates improved use of wound dressings, efficiency gains of over £140 million. The PCE programme has thus delivered huge benefits since its inception and continues to do so with new programme additions.
Summary:
This work has significantly improved the use of medicines and indeed dressings use across Northern Ireland whilst at the same time delivering large efficiencies in terms of annual expenditure in both primary and secondary care. Further there has been a considerable degree of re-engineering medicines processes both within and between care sectors. A novel procurement methodology (STEPSelect) was developed and is now used routinely as was a pharmacist intervention recording system (EPICS). The programme is now looking at intermediate and nursing home settings as well as virtual wards and optimising medicines management Medical device procurement is also being undertaken using the model developed for medicines .The work is also feeding very effectively into the Regional Transforming Your Care programme. Elements of the work have been copied in England, Sweden ,the Netherlands and South of Ireland.