1. Andrew Cooke MRPharmS Assistant Director: Head of Medicines Optimisation NICE Medicines and Prescribing Centre Associate Member of NHS England Medicines Optimisation Steering Group Using the Medicines Optimisation Dashboard to support patient care #MOdashboard @cookie_andy

2. This session will cover… Why have a Medicines Optimisation Dashboard What it is How to use it to benefit patient care

3. Medicines have a vital role to play Medicines: Prevent life-threatening diseases Help to change previously life-threatening illnesses to long-term conditions eg HIV Improve the quality of life for people with long-term conditions Reduce mortality across a wide range of diseases and thereby help increase life expectancy They are the most common therapeutic intervention - NHS spends £14.4 billion each year on them – 15% of its annual budget.

4. But there are issues that prevent their effectiveness… Patients report having insufficient supporting information Poor adherence: 30 - 50% of medicines not taken as intended Medicines wastage in primary care: £300M pa with £150M pa avoidable UK literature suggests 5% - 8% of hospital admissions due to preventable adverse effects of medicines

5. In addition… Inadequate review and monitoring of medicines outcomes Polypharmacy Uptake of newer medicines can be patchy Unwarranted variation in use of medicines across England Real threat of antimicrobial resistance Unacceptable level of medication error

9. Principles of Medicines Optimisation

11. 1. Improving national awareness Good is when: Patients can say with confidence “I know & feel secure about where to go to get support” There is appropriate signposting to services available through the website, GP, Pharmacist & it clear when a patient should/can go to one over the other. 2. Enriching consultations Good is when: The health professional has conversations with the patient to understand their lifestyle & how the medicine will affect their lifestyle Proper time is allowed to enrich the consultations (the current time of 10 minutes allotted to GP appointments is not enough) It is good all the time – reliable & consistent service What patients have said they want…. https://www.england.nhs.uk/wp-content/uploads/2015/05/mo-patient- panel.pdf https://www.england.nhs.uk/wp-content/uploads/2015/05/mo-patient- panel.pdf

12. 3. Encouraging patients to be more responsible & honest about their attitudes & behaviours Good is when: Patients feel comfortable to say what they think and be honest about how they’re using (or not using) their medicines Patients understand their responsibility in taking their medicines (not just their rights) 4. Encouraging the provision of better information & support Good is when: Knowing what the medicine is for, when to take it, what to do if I forget and what side effects to look out for 5. Value for Money Good is when: There is reduced wastage Patients appreciate the value of medicines What patients have said they want…. https://www.england.nhs.uk/wp-content/uploads/2015/05/mo-patient- panel.pdf https://www.england.nhs.uk/wp-content/uploads/2015/05/mo-patient- panel.pdf

13. Key priorities for implementation Systems for identifying, reporting and learning from medicines ‑ related patient safety incidents Organisations should consider using multiple methods to identify medicines ‑ related patient safety incidents – for example, health record review, patient surveys and direct observation of medicines administration. They should agree the approach locally and review arrangements regularly to reflect local and national learning. Medicines reconciliation Organisations should ensure that medicines reconciliation is carried out by a trained and competent health professional – ideally a pharmacist, pharmacy technician, nurse or doctor – with the necessary knowledge, skills and expertise including: effective communication skills technical knowledge of processes for managing medicines therapeutic knowledge of medicines use Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes NICE guidelines [NG5] Published date: March 2015

14. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes NICE guidelines [NG5] Published date: March 2015 Medicines ‑ related communication systems when patients move from one care setting to another Health and social care practitioners should share relevant information about the person and their medicines when a person transfers from one care setting to another.

16. Medicines Optimisation Dashboard Produced by NHSE England in collaboration with ABPI, BGMA, RPS, BSA, DH and HSCIC Audience – CCGs and Trusts but AHSNs and LPNs are using Prototype launched June 2014 Evaluation September - January Updated 16 th November 2015 Long term work plan

17. Medicines Optimisation Dashboard We hope that CCGs and Trusts review this information together and agree how to use it locally. It will be important for Local Professional Networks, Strategic Clinical Networks and Academic Health Science Networks to use the indicators in their collaboration with patients, Clinical Commissioning Groups, Trusts and the Pharmaceutical Industry to support local improvement. The dashboard is presented to allow local NHS organisations to develop improvements. It is not intended as a performance measurement tool and there are no targets.

18. Information in the Dashboard Data Types: – Prescriptions / Prescribing – QOF – Admissions Community Support – MURs – NMS – EPS – RD Patient Safety – Reporting – Access to SCR – Medicines reconciliation Biosimilars Therapeutic areas – CVD / CHC – Mental Health – Antibiotics – Diabetes – Osteoporosis – Respiratory

22. Variation : innovation? Identify innovation = opportunity to learn and improve

25. Back to the Future: 1985 - 2015 Hand held computers and video calls? yes Hover-boards? no Electronic prescriptions?…..

26. April – June 2015 England Average = 25% (up from 15% in 6 months)

27. Use of Repeat Dispensing Evidence: 2002 data showed if 80% of repeated medicines were managed as Repeat Dispensing, 2.7 million GP practice hours would be freed up. England average 2015: <8%

29. Medicines Use Reviews (MURs) An evaluation of the discharge MUR in Wales showed that 87% of patients had discrepancies in their medicines on discharge from hospital. Resources valued at around £3 million were freed up (avoided A&E attendances, hospital admissions and drug wastage) where discharge MUR s were utilized. This was £3 for every £1 spent.

30. Sub optimal medicines use Ten days after starting a new medicine, 30% of patients are already non-adherent. At four weeks, 26% of patients say that a new problem has emerged. Just 16% of patients who are prescribed a new medicine are taking it as prescribed, experiencing no problems and receiving as much information as they believe they need.

31. New Medicines Service Evaluation showed a 10% increase in adherence in those patients receiving the New Medicines Service

33. Medicines Safety Incidents Something widely feared as a possible unpleasant or dangerous occurrence. Spectre

38. Patient Safety Audit Software: e.g. PRIMIS PINCER Use of the PINCER Software has been shown in a randomised controlled trial to reduce the risk of medication errors to patients in primary care. The only data contained in the dashboard is that derived from the PRIMIS PINCER (A pharmacist- led information technology intervention for medication errors) toolkit. Other software that includes PINCER searches are available such as Eclipse Live.

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40. NMS MUR COPD Admissions QOF: COPD Reviews

41. Marginal Gains Dave Brailsford believed that if it was possible to make a 1% improvement in a whole host of areas, the cumulative gains would end up being hugely significant. Each weakness was not a threat, but an opportunity to make adaptations, and create marginal gains. Rapidly, they began to accumulate. Team GB used to be also-rans in world cycling. But in the last two Olympics, Team GB has captured 16 gold medals and British riders have won the Tour De France three times in the last four years. This is the power of a questioning mind set and a commitment to continuous improvement. "The whole principle came from the idea that if you broke down everything you could think of that goes into riding a bike, and then improved it by 1%, you will get a significant increase when you put them all together,"

43. “Continuous improvement is better than delayed perfection.” Mark Twain