1. 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

2. 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.

3. 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

4. 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

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

6. 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

7. 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)

8. 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 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.

9. 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

10. 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

11. 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

13. 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

14. 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.

15. 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

16. 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!

17. Safer medicines report summary