Commissioning for Safety- Developing an integrated Pharmacy Team for Salford Claire Vaughan- Head of Medicines Optimisation, Salford CCG Lindsay Harper- Director of Pharmacy, Salford Royal Care Organisation

Commissioning for safety Safer Medicines The Safer Medicines programme aims to identify innovative ways to improve medicines optimisation in collaboration with patients and professionals from across the health and care system.

Commissioning routes used Local CQUINs Medicines related admissions Improving the accuracy of discharge information for medicines Primary care quality contract ( Salford Standard) Reducing patients numbers with prescribing safety indicators (PINCER indicators) Salford CCG Innovation Fund Electronic referral and transfer of discharge information to community pharmacy and GP practice pharmacists Pharmacy technicians in intermediate care and care homes Medicines safety pharmacist EPIFFany blended learning on prescribing –extended to community

Integration and learning from Safer Medicines Aim: to ensure medicines are always correct at any point in the patient journey Currently measure at entry to Salford Royal Foundation Trust Currently measure at entry intermediate care entry Starting to measure at return to primary care Starting to measure in care homes Aim: Shared understanding of safety across the health economy with medicines Health economy medicines safety group Integrated workforce

Pharmacy Projects to discuss NIPPS Team SRFT Medicines Related Admissions Improving discharge accuracy E-pharmacy referrals ICO Pharmacy Teams

Neighbourhood Integrated Practice Pharmacists in Salford Team of practice pharmacists employed by SRFT and Salford Primary Care Together GP Practice commissioned by Salford CCG. March 2019- 28 pharmacists (20 wte) Now supporting all 44 Salford GP practices. Menu of services provided to GPs Medicines Reconciliation post discharge Poly pharmacy reviews High risk medicines reviews In 2017/18- over 25,000 medicines reviews completed Focus work areas: AKI & CKD, Respiratory , AF, Mental Health

Improvement on the medication safety measures included in the University of Manchester Dashboard (SMASH) Improvement on the medication safety measures included in the University of Manchester dashboard (SMASH)

Medicines Related Admissions SRFT Clinical Pharmacists identifying if a patient’s admission is related to medicines Recording it on the EPR and alerting the clinical team Automatic email to MI pharmacist to enter yellow card Referral made to the relevant GP practice pharmacist for post discharge medicines review SRFT pharmacists identifying ~ 55 a month Challenge- correctly coding the admission and the medicine involved.

Future Develop feedback pathways into primary care Currently patient specific to prompt localised audit Develop feedback pathways into secondary care in response to data from ADRs during admissions Linking admissions data to causative medicines via coding I.e. NSAID related GI bleed being coded Showing change in admissions in response to projects in primary care prompted by MRA data MRA data to track other risks e.g. number of overdose, prescribing/dispensing/administration errors

Improving accuracy of information regarding medicines on discharge prescriptions Audits completed on the % accuracy of documented medication changes on two wards Improvements seen on medical ward but not surgical ward Training delivered to junior doctors by GP and pharmacy staff Discharge checklist developed for junior doctors Test of change- to enter whether medicine- new, dose changed or stopped on electronic prescriptions

Electronic Pharmacy referral systems Working with GM AHSN, GM LPC and GM LPN. Develop a system that can be spread across GM (Workstream 1- Public Health- seamless care) Referral orders built into Allscripts EPR for hospital pharmacists to refer to community pharmacist through PharmOutcomes Electronic copy of discharge attached for community pharmacists ( Live from Feb 19) Approx ~ 50 referrals a week Improved communication with Care Homes

Further roles for Pharmacy Salford Together(ICO) have included pharmacists and pharmacy technicians in the plans for: Falls team Urgent Care team Enhanced Care Neighbourhood teams Care Homes Pharmacist and pharmacy technicians Ensuring medicines optimisation and safety is at the centre of the new systems we are developing in Salford

Prescribing Pharmacist role within Enhanced Care Team (Enhanced care team take over care of at risk patients for six weeks) Pharmacist is:- Taking an active role in the weekly MDT; discussing care plans for patients including any changes to medicines Delivers structured medication reviews to support the effective use of medicines Using non-medical prescribing qualification and skills as a clinical pharmacist to optimise medicines, involving patients to improve the use of medicines Providing advice and assessment for patient’s conditions for example BP, pulse, peak flow and inputting into clinical management plans used to directly manage patient care Liaising with local community pharmacies to ensure medication changes are actioned in a timely and accurate manner.

SUMMARY OF MEDICINES OPTIMISATION TEAMS ACROSS SALFORD Salford Care Homes Pharmacist and Technician Salford Royal Board of Directors Electronic Prescribing/ Pharmacy Team Salford Medicines Optimisation Pharmacy Technicians Safer Salford Team Acute Clinical Pharmacy Team Salford Royal Pharmacy Department Salford Royal Clinical Effectiveness Committee Salford CCG Medicines Optimisation Team System wide Antimicrobial Pharmacist Community Pharmacy LPC Medicines Safety Pharmacist System Wide Salford Medicines Safety Committee Care Homes Pharmacist ICO Pharmacy Team Community Services including Urgent Care / Enhanced Care and Falls Pharmacists plus Intermediate Care Pharmacy Technicians Salford Primary Care Together GP Practice Care Homes Pharmacy Technician Salford GP Practice Pharmacist Team Mental Health Clinical Pharmacy Team

Thoughts of the team Positives Challenges TIME! Data sharing Increased opportunities to improve medicines safety across the health economy Effective team working between SRFT, CCG and community Pharmacy Teams The support of the CCG with innovation money Excellent electronic systems Data sharing Traditional boundaries Sharing our learning TIME!

Safer medicines report summary