Bridging the Gap collaborating to spread improvement National Medicines Management Programme & All Wales Chief Pharmacists Sept 7 th 2012 All Nations Centre, Cardiff

Andrew Cottom CEO Powys LHB Chair – National Medicines Management Programme Year 1 – Foundations The Answer is in the Room Top 14 measures Prescribing Dashboard & Accelerator National Formulary System & MTED Links with AWMSG Year 2 – Building Blocks Restrain the escalation of the drug spend Reduce unit cost Reduce volume Increase will Year 3 – Operational Spread with interventions and SBARs Planning & measurement Whole System Thinking Electronics & Technology

Anne Bithell Chair – Welsh Chief Pharmacists Committee Chief of Staff Pharmacy & Medicines Management CPG BCUHB Aim of the day Develop plans to increase the will and capacity to spread improvement

Progress to date Year 1 – Foundations The Answer is in the Room Top 14 measures Prescribing Dashboard & Accelerator National Formulary System & MTED Links with AWMSG Year 2 – Building Blocks Restrain the escalation of the drug spend Reduce unit cost Reduce volume Increase will Year 3 – Operational Spread with interventions and SBARs Planning & measurement Whole System Thinking Electronics & Technology

Learning & Spreading Morning session – each LHB to share learning from a project Afternoon session – how do we plan, influence and spread

Programme (morning) 09:30Registration/Network/Refreshments (Part1) 10:00Welcome, introduction & today’s purposeCo Chairs 10.15The journey to sustainable and widespread improvement – medicines matter. Professor Dyfrig Hughes 10.45Medicines Matter – Movement & Improvements Market Health Boards improvement tables 12.00People of influence from the patient to the professional – medicines matter Jamie Hayes 12.30Key learning and messages (part 1 close)Co Chairs

Programme (afternoon) 12:45 – 1.30Network & LUNCH (Part 2) 1.30Introduction and scene settingCo Chairs 1.40Using influence to effectively spread improved practice – Steve J Martin Master class 3.00 BREAK 3.15Using influence to effectively spread improved practice – Steve J Martin Master class 3.55Leading messages, thanks and close. Co Chairs

How can we influence and spread our interventions?

Who to Influence? Strategic level Operational level Patients and service users

How to Influence? Education and training Incentives Publications and newsletters Etc.

Example Intervention at BCUHB Stopping the drug (Poly-pharmacy) Aim: To reduce levels of poly-pharmacy by 5% in 6 months Measure: “The % of patients over 65 with 15 or more items* on their repeat slip” (*this may include dressings etc) Intervention: Review 20 patients as a learning tool.

Example run chart and possible interventions 22/06/ Review 20 patients Partners meeting; GP champion found Med review added to LES Think again? What are other practices like? Get specialist help from hospital Do “clean up search” Peer review & education session Link in with MURs The test practice had 1,800 patients over 65; 58 with over 15 items

What are the gaps to bridge? Financial Professional Structural Cultural Innovation & Technological

AimPrimary DriversSecondary DriversInterventions Ordering  Patient orders from surgery  Patient orders from pharmacy  Pharmacy managed repeats  Care Homes  Synchronisation; on line ordering, repeat slip  Repeat dispensing  Monitor waste  Care Home policies/training Reduce Medicines Waste Prescribing  Care Homes  Adverse effects  Dosage form (inability to swallow, use device etc)  Acute illness  Hospital discharge  National Guidance/Guidelines  Formulary  Patient Demand  Bulk ordering, MDS, Dressings supplies  28 day prescribing, medication review  Specials, inhaler technique training  Quantities e. g. analgesics, NSAIDs  Medicines reconciliation on discharge  1000 Lives /LES  Targeted discharge MUR  ScriptSwitch  Formulary compliance reporting; LES  No on demand prescribing of OTC medicines Usage  Medicines adherence  Carer skills & knowledge  Concordance  Targeted MURs, inhaler technique,  Carer support, training & advice  MURs Awareness  Health professionals  Public  Publicity (TV, radio campaigns)  Advertising (leaflets, back of buses)  Patient education (antibiotics etc)  Cost awareness  Increase OTC awareness

What are we trying to achieve?