EMOP Electronic Medicines Optimisation Pathway Gerald Zeidman – Chief Officer Bedfordshire Local Pharmaceutical Committee

What is EMOP ? Transfer of discharge information from hospital to community pharmacy.

Who is Involved The Lister Hospital, Stevenage (More may come on at a later date) EAHSN – Eastern Academic Health Science Network Pinnacle Healthcare – Pharmoutcomes Community pharmacy

Louise Venables Project Coordinator Eastern AHSN

Eastern AHSN Our role is to help improve both the health and wealth of local people. We do this at a time when the NHS is facing a period of unprecedented challenge. Promoting economic growth: fostering opportunities for industry to work effectively with the NHS. Diffusing innovation: creating the right environment, and supporting collaboration across boundaries, in order to adopt and spread innovation at pace and scale. Improving patient safety: using our knowledge, expertise and networks to bring together patients, healthcare staff and partners to determine priorities and develop and implement solutions. Improving quality and reducing variation: by spreading best practice we increase productivity and reduce variation, thereby improving patient outcomes. Putting research into practice: our strong links with academia mean we are uniquely placed to support the translation of research into clinical practice. Collaborating on national programmes: our unified programmes focus on delivery of the SBRI Healthcare initiative (supporting SME interaction), the NHS Innovation Accelerator and Patient Safety Collaboratives.

Our region Cambridgeshire and Peterborough, Norfolk and Waveney, Suffolk and north east Essex, mid and south Essex, Hertfordshire and the eastern border of Bedfordshire Over 6 million people 34 local authorities 13 Clinical Commissioning Groups (CCGs) 6 Sustainability and Transformation Partnerships (STPs) Life science business sector support Innovation, business and research centres across Cambridge, Stevenage, Chelmsford and Norwich Introduction to region (note we have a new map to replace this one). Will be sorted post annual review publication

https://InnovationExchangeEast.org/ Support to innovators through access to advice and guidance and through our partnership with National Clinical Entrepreneurs, SBRI Healthcare and the MedTech accelerator. Support for a limited number of development projects throughout the year, designed to prove a concept works and minimize the number of repeat pilots that occur in the system. Adoption and spread Development Support the NHS to adopt proven innovations, that have been nationally selected for wide scale adoption. To find out more on which innovations have been selected and how to nominate an innovation for consideration. Matching Needs analysis Bringing together an interested community of professionals, citizens and innovators from throughout the region to match needs with solutions. Innovator support Support to development of clear statements of need, co-produced with citizens and linked to evidence and data, with a view of future proofing the solutions. https://InnovationExchangeEast.org/

Electronic Medicines Optimisation Pathway (EMOP) Lister Hospital Andrew Hood - Chief Pharmacist Sarb Sarai - Pharmacist Advanced - Critical Care East and North Hertfordshire NHS Trust March 2019          

What is the Electronic Medicines Optimisation Pathway (EMOP) This is the locally agreed name in the East of England region for the secure electronic sharing of medicines information on TTAs (TTOs), following discharge from inpatient units, between hospital pharmacy and community pharmacy using the PharmOutcomes platform. This project originated from Hertfordshire and West Essex STP who recognised the value of the project and rolled it out across acute trusts across their region.

Background of EMOP Research repeatedly shown that patients often experience errors or unintentional changes to their medicines when they move between care providers, presenting a significant risk to patient safety. 30-70% of patients experience unintentional changes to their treatment or an error is made because of a lack of communication or miscommunication(2). Only 16% of patients who are prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need(3). 20% of patients have been reported to experience adverse events within 3 weeks of discharge, 60% of which could have been ameliorated or avoided(4).

Key drivers To reduce emergency bed days and length of stay and reducing drugs waste Improving the safe transfer of information about a patient’s medicines has been shown to reduce the incidence of avoidable harm to patients Priority improvement area for the NHS backed by NHS England through the Academic Health Science Networks. Successfully implemented in other areas nationally eg Southampton area, Merseyside, Newcastle

Benefits Evidence has demonstrated that informing community pharmacists of medication changes can lead to: Improved patient care and patient experience by sharing information, requesting follow up services for the patient and ensuring medication changes are acted upon in primary care Reduced readmission rates. Reduction in drug waste / unnecessary dispensing in community. Improvements in the consistency of prescribing. Enhanced collaboration with GPs and secondary care in order to reduce unintended medication errors Improved medicines support for patients recently discharged from hospital. Significant increases in medicines adherence, leading to improved health outcomes for patients

Process Hospital pharmacists will refer “for information only” Community pharmacists, on receipt of referral, in their professional capacity, will decide on what action to take e.g. MUR, NMS, support for the patient, medicines reconciliation

Process During the medicines reconciliation process the hospital pharmacist will Provide patients with the EMOP patient information leaflet (PIL). Be mindful of patients that may require easy read PIL. Document verbal informed patient consent by the pharmacist ticking NMS/referral box & signing on the medication chart Request the name of the chosen community pharmacy (CP). Confirm patient contact details are correct informing the patient that the CP may contact them after they have been discharged. Obtain the ODS code for the chosen community pharmacy by clicking on the PharmOutcomes live link on the desktop and entering the pharmacy name. Please note that Sarb Sarai will send out this live link via email. The ODS code and pharmacy name can be documented on the medication chart in the community pharmacy box.

Process When the patient is due to be discharged from hospital TTO will be validated by the hospital pharmacist in the usual manner with the following additions: Add an extra medication to the TTO called refer to pharmacy and enter the ODS code in the comments column. Once TTO is verified, go into the discharge letter and free type any medicines that have been stopped. A standard data set including list of medicines on TTO, will automatically be sent over to the community pharmacy (CP) when the patient is discharged at approximately the same time

Process A pre populated field with the phone number of Lister Medicines Information is sent to community pharmacists (CP) as part of the referral. In the event of a query from a CP, the MI pharmacy staff can refer to the appropriate ward pharmacist. The CP can accept or reject referrals. Rejected referrals will be sent back to the hospital pharmacy. This information will be collected for statistical purposes only. The hospital pharmacy is not required to re refer.

Discharge information On Patient Discharge from Hospital GP Practice Team continues to receive discharge information through existing channels Hospital pharmacy team provides information to patient and obtains consent and name of chosen pharmacy Automated notification & transfer of medicines discharge information Community Pharmacy 1.Reviews discharge medicines information 2. Reviews any outstanding Rx 3. Cancel unwanted Rx & query new Rx 4. Carry out MUR, NMS 5. Patient consultation 6. Enhanced communication with GP practice 1. Adds note to practice clinical system 2. Post discharge meds reconciliation 3. Act on any new Rx query

Community Pharmacy Demonstration PharmOutcomes Community Pharmacy Demonstration https://www.eahsn.org/resources/emop-training-resources/

Why Bother ? Most Pharmacists have asked for it for years Helps improve clinical care of patients Demonstrates the clinical nature of community pharmacy Integrates community pharmacy into the NHS Improves patient safety Evidence the value of Community Pharmacy Knowledge is KING !!!

How many referrals will I get Depends on hospital policy of referrals Anticipate start small but increase over time Herts and West Essex STP have agreed with the Lister hospital a target of 5 per day currently, which will increase to 9 after May 2019. Bedfordshire contractors will receive a 30% of this target

So should I be part of this project?

Benefits to community pharmacy Allows you to talk to your patient Plan your work Reconcile medicines on 1st Rx post discharge Support and advise patients Recommend additional services – NMS, MUR, Smoking cessation etc Work collaboratively with the GP

What’s the fee? No fee as just helping you to do what you do but better However this enables additional services Example of what could you do? NMS 25 MUR 28 Flu Jab 10 TOTAL £63 Plus other local PH services

How do I sign onto the Project? All pharmacies will automatically be opted in to the EMOP project. If you wish to opt out to EMOP Project you must complete a hard copy opt out form (available this evening) and return it to the LPC.

Bedfordshire LPC contractor support Ethel Shaw, Business Manager, Bedfordshire LPC

Helen Musson HertsLPC Executive Officer Hertfordshire LPC Experience Helen Musson HertsLPC Executive Officer

Case Studies- Hertfordshire Bell Chemist in Hitchin Jackmans Pharmacy in Letchworth

EMOP Data Lister Hospital July 18 to Feb 19

Referral Numbers Referrals Basildon Southend West Suffolk Lister PAH Number of referrals 1397 2073 268 475 140 Number of referrals awaiting action 657 47% 781 38% 2 1% 96 20% 40 29% Number of referrals accepted 308 22% 517 25% 12 4% 78 16% 28 Number of referrals completed 334 24% 692 33% 234 87% 254 53% 26 19%

Lister Referral Status- Totals and percentage Total number of completed patients % of completed patients

Talking Tables

Q&A and next steps