2. Smarter Medicines Better Outcomes
NICON2018
@moicni #nicon18

3. Your speakers Cathy Harrison Deputy Chief Pharmacist
Department of Health
Professor Mike Scott
Director
Medicines Optimisation Innovation Centre (MOIC)
Director of Pharmacy and Medicines Management
Northern Health & Social Care Trust

4. Medicines use in Northern Ireland
1.8m people
More than £550m per year
More than 40m items
Accounts for 12% of HSC spend
19.9 items per head
Increase of 5% each year
Higher number of prescription items per head than England and Scotland
Higher costs per head than any other UK country

5. Sub-optimal outcomes from medicines
3-6% of hospital admissions due to adverse effects, rising up to 30% in the elderly
1 in 15 hospital admissions are medicine related with two thirds being preventable
1 in 20 GP prescriptions contains an error
30-50% non-adherence to prescribed medication
2.5 million doses are administered in the average acute hospital (215,000 errors)
In the UK it is estimated that such errors cost £770M*
Variance of practice
* 2007 figure

6. Medicines Optimisation
“a person centred approach to safe and effective medicines use to ensure the best possible outcomes from their medicines”
Definition by NICE

7. Medicines Optimisation Quality Framework
Developed in response to the need to gain better patient outcomes from medicines and ensure effective use of healthcare resources, uses the Medicines Optimisation Model.

8. The Model

9. Key goals for medicines optimisation
Support better adherence with prescribed medicines
Improve polypharmacy management
Reduce harm for high risk patients and medicines
Support safer transitions of care
Increase averse drug event reporting
Increase knowledge, capacity and skills in health literacy
Optimise the use of medicines resource within the HSC

10. Closing the gap

11. Medicines Optimisation Innovation Centre
Research
Quality Improvement
Knowledge transfer
Innovation

12. The Innovation Pipeline
Regional scale and spread
Regional scale and spread
Quality Improvement and Innovation projects
MO Steering Group
Innovation work stream

13. Integrated medicines management (IMM)
Drug history at admission reduction of 4.2 errors per patient
Length of stay reduced by 2 days
Increased time to readmission (20 days)
Kardex monitoring (inpatient) 5.5 interventions per patient
Faster medication rounds > 25 minutes per day saved
Faster discharge > 90 minutes quicker
More accurate discharge < 1% error rate compared to 25%
Reduced risk adjusted mortality rate

14. Improved medicine use
There was a significant improvement in the Medication Appropriateness Index (MAI)*
Control
Intervention
*Burnett ,Scott ,Fleming et al. Am J Health System Pharm. 66;
Admission
Discharge

15. Risk Adjusted Mortality Index

16. MO: completing the picture Systematic testing and scaling
Post discharge follow up (NHSCT)
Mental Health pharmacist (BHSCT and SHSCT)
Doctor light discharge (NHSCT and SHSCT)
Practice based pharmacists (HSCB)
Out of hours supply (HSCB)
Benzodiazepine use (HSCB)
Community pharmacy
(PACT and MEAPP)

17. MO: completing the picture Systematic testing and scaling
Medicines Optimisation in Older People (MOOP)
Intermediate care (WHSCT)
Care homes (NHSCT)
Adherence Pharmacist (SEHSCT and NHSCT)
Consultant Care of the Elderly Pharmacist Network

18. Case management project
Queen’s University Belfast
Wessex Academic Health Science network
Eastern Academic Health Science network
North West Coast Academic Health Science network
Association of British Pharmaceutical Industries (ABPI)

19. Educating and training colleagues via knowledge transfer
Top row – denmark, Norway, ireland, Sweden, UK, Netherlands
Bottom row – Egypt, estonia, Jordan, New Zealand, Palestine, Poland and Spain

20. Tallaght Hospital Dublin Ireland (PACT)
What is this showing? Suggest we remove?

21. European Innovation Partnership on Active and Healthy Ageing
2016
EU Reference site
4 stars
Twinning with NW Coast, Catalonia & Oloumuc

22. European Connected Health Alliance
The Global Connector in Healthcare
Bringing people, organisations, needs and solutions together
Medicines Optimisation inter-ecosystem group
@ECHalliance
What is the purpose of this slide / title / do we need it?

23. Pharmaceutical companies
Currently scoping a project related to an outcomes based value model including Health Economics (SEHSCT, NHSCT, WHSCT, GP Federations, Clinical Information Officers )
Looking at physical health aspects related to mental health medications( WHSCT, BHSCT, SHSCT and NHSCT)

24. Non pharmaceutical companies
HCAI
Point of care testing
Iskus Health Ltd
Goldshield Ltd
Cardinal Health
Data Analytics
Hibergene
Accelerate
Healthcare Analytics Ltd
Analytics Engines Ltd

25. Enabling technology
Safe therapeutic economic pharmaceutical selection (STEPSelect)
Electronic pharmacist intervention clinical system (EPICS)
Medicines reconciliation and analytics software (Writemed)
Antimicrobial surveillance system (LAMPS)

26. Medicines optimisation: Small Business Research Initiative(SBRI)
How can technology help people to take their medicines on time and as prescribed?
HOME
How can technology help improve medicines use for service users and service providers in domiciliary care?
FAST
How can technology help optimise the use of pharmacy staff in hospitals by matching skills to patient acuity in real time?

27. Current collaborative funding bids
Dutch Private Foundation
Implementation of antimicrobial stewardship in hospitals in Ghana
Interreg
Our Lady of Lourdes Hospital Drogheda
Queens University Belfast
Trinity College Dublin
CoST
In association with European Colleagues led by Catalonia
Norwegian Research Council
with Norwegian, English and Swedish colleagues
Dutch Private Foundation - Implementation of microbial stewardship in hospitals in Ghana
Interreg- with colleagues in Our Lady of Lourdes Hospital in Drogheda , Trinity College ,Dublin , The Queens University of Belfast
CoST - with a number of European Colleagues led by Catalonia
Norwegian Research Council- with Norwegian, English and Swedish colleagues

28. WHO Global Challenge: Medication without harm
Polypharmacy
Safer transitions of care
High risk medication situations
Aim: medication harm reduction of 50% by 2023

29. cathy. harrison@health-ni. gov. uk @cathyharrison00 moic@northerntrust
@cathyharrison00 @moicni