1. Cost Savings and Avoiding Wastage
A Medication Journey

2. Patients Own Drugs (PODs)
POD letters
Use green POD bags
All staff should be POD trained
Use PODs whenever suitable
One stop dispensing whenever possible
Bring examples of the two types of POD letter – encourage bringing PODs into the Trust
POD bags may be given to patients on admission via ambulance or A&E. Patients with frequent admissions are starting to be targeted for green bags by community pharmacies and GPs.
Talk about POD training and one stop training for nursing staff across Trust and localities
Discuss advantages of one stop

3. Drug Budgets 2010/2011 Budget £4.54 million Spend £4.98 million
(Large increase includes budget for Hampshire CAMHS)
Everyone can do their part to keep within budget

4. Medication Journey How can we help? One Stop if appropriate.
Use PODs, ask for them to be brought in.
One Stop if appropriate.
Transfer all named items with the patient if they move ward, except CDs.
On discharge make sure all currently prescribed items are given to patient.
What are the most likely items to be missed?

5. Items which get overlooked
Remember it’s not just the cost but the inconvenience to patient/GP/ward
Examples of items often forgotten:
Inhalers: e.g Seretide ‘250’ ; Spiriva Handihaler
Eye drops: branded packs e.g Lumigan & Xalatan
Fridge items: prefilled insulin pens Lantus
Topicals: Dovobet Ointment
Costs ask if nurses have any idea of cost.
Costs: Seretide 250= £59 Spiriva Handihaler= £34 ; Branded eye drops e.g. Lumigan & Xalatan = £ Insulins penfills Lantus £ Dovobet Ointment 60g = £ 33

6. Small study on OPMH ward
Findings after 3 months from just 7 patients who were discharged.
£ TTOs ordered when one stop medication already on ward.
£12.55 was the actual cost of medication which did need to be ordered to complete the TTO
£ wasted medication which should have gone home with the patient.
The study over 3 months included all 7 patients who were discharged during the study period. These amounts do not include the charge for the time and cost of dispensing. Many of the items charged to the ward and left behind after the patient has been discharged cannot the returned to pharmacy stock and will be disposed of.

7. Pilot study 2011 OPMH 12 bed ward
6 month study evaluated the cost effectiveness of clinical screening by pharmacist prior to discharge summaries being sent to pharmacy.
May 2011 £1305 Ave. spend before pilot £1444
June 2011 £1654
July 2011 £1373 Ave. spend after pilot £ 1058
Aug 2011 £706
Sep 2011 £1002 Ave. saving/month £386
Oct 2011 £978
Nov 2011 £994
Dec 2011 £1612
In a second study ,12 bed OPMH assessment ward. Prior to the study discharge letters were sent directly to Southlands pharmacy for a 14 day supply regardless of what was already on the ward. A remote clinical screening system was set up enabling the pharmacist to indicate which drugs if any needed to be dispensed. Average monthly spend on TTOs was reduced by almost £400. This does not include the cost of disposal of wasted medication. The pilot is ongoing.

8. Tips for cutting down costs I
Avoid liquids and orodispersible preps. unless essential. Review regularly and before discharge.
Many patients say they cannot swallow tablets but simple techniques can be used to teach and re-assure a patient that they will not choke.
Make use of the Trust guidelines “swallowing pills”
Liquids can cost up to 10 x as much as tablets e.g temazepam. Food supplements often get re-written on drug charts without review being carried out. Have copies of the “swallowing pills guidelines standard and CAHMS

9. Tips for cutting down costs II
Assess need for food supplements regularly
If patient is on “One stop” do not order leave/discharge medication without checking the trolley first
Ask for PODs to be brought in if not available on admission
Transfer all medications if a patient moves ward.
Food supplements often get re-written on drug charts without review being carried out. Patients or relatives could bring PODs in after admission if asked. See posters . Send all named individually dispensed medications when patient is transferred with the exception of CDs which have been ordered in ward order book.

10. Cost effective prescribing tips for Doctors I
Quetiapine IR tabs have come off patent, use instead of XL preparations.
Venlafaxine XL tablets cheaper than XL capsules
The supply of newly started medications should be transferred to the patient’s GP to continue where possible (exceptions include clozapine).
Do not prescribe physical drugs or feeds in the community.
Here are some examples of tips which the medics have been asked to follow. Cost effective prescribing tips have been produced for specialist teams, these are sent out directly to the consultants; have examples to show. Quetiapine XL should only be used for the first 2 days of treatment when initiating treatment. In the community venlafaxine XL tablets are cheaper than capsules.
Produced for each specialty by Ray Lyon, Chief Pharmacist.

11. Cost effective prescribing tips for Doctors II
Do not use the term “Velotabs” if prescribing orodisperible tablets in the community as this is a brand name and Zyprexa will be dispensed.
Review need for higher dose long-acting injections this could save up to £817 per annum.
Pregabalin should be prescribed as BD rather than TDS as same price irrespective of strength.
Prescribe ADHD medication which is available in UK Concerta XL 54mg = £73.62 (2x27mg) Concerta XR 54mg > £600 (imported)
Velotabs and Quicklets are part of a brand name and should not be used otherwise the parent drug e.g Zyprexa/Risperdal will have to be dispensed.
A switch from 50mg Consta to 37.5 would save £817 per annum, doctors should review whether a patient could be maintained on a lower dose. It is significantly cheaper to prescribe BD rather than TDS pregabalin; 100mg TDSx28 days= £96.60 ; 150mg BD = £64.40 Only UK licensed products should be used sometimes drugs can have very similar names e.g Concerta preparations.

12. Remember everybody can help… “your Trust needs you”!!
Cost savings
Remember everybody can help…
“your Trust needs you”!!
Any questions