MEDICINES OPTIMISATION


aS NORthERN IRElaNd'S agEINg POPUlatION INcREaSINgly RaISES cONcERN, thE PROVINcE'S hEalthcaRE PROfESSIONalS aRE lEadINg thE way IN INNOVatIVE RESPONSES that aRE attRactINg NatIONal aNd glOBal attENtION...


NI lEadS thE way IN mEdIcINES OPtImISatION


t


he increasingly ageing population of Northern Ireland (NI) means that the prevalence


of chronic disease will also increase. as a result, the need for medicines is expected to rise: a fact, which will place direct pressure on prescribing budgets and lead to an increased demand across health and social care services, particularly those involved with the prescribing, dispensing and administration of medicines.


fortunately, the province's healthcare professionals have been focussing on this issue for some time and have already received national and international recognition for their efforts.


In june this year, NI achieved the highest recognition of 4-Star Reference Site status from the European Innovation Partnership (EIP) on active and healthy ageing (aha).


the European Innovation Partnership in active and healthy ageing (EIP on aha) was established by the European commission to foster innovation in the field of active and healthy ageing. the overarching target of the partnership is to increase the average healthy lifespan of EU citizens by two years by the year 2020.


In 2012, the department of health, Social Services and Public Safety (dhSSPS) responded to a request from the European commission for commitments to be made to achieve


24 - PhaRmacy IN fOcUS


the EIP on aha objectives. at the same time the commission invited 'regions', 'cities' and 'integrated hospitals/care organisations' that could demonstrate a comprehensive, innovation-based approach to active and healthy ageing, along with evidence based examples of good practice to apply for Reference Site status.


In may that year NI applied for Reference Site status and was one of thirteen Reference Sites to be awarded 3-Star Reference Site status in july 2013, with special recognition for its integrated medicines management work.


Reference Site status raised the North’s profile across Europe as an exemplar in a number of areas of health and care. One example of this is that it helped the newly-established medicines Optimisation Innovation centre (mOIc) to pursue collaborative working agreements with England, Serbia and Poland, develop and submit a number of EU funding bids and establish an international knowledge transfer hosting programme.


In june this year, NI re-applied for Reference Star status and was awarded 4-Star accreditation: the highest level that can be awarded, making the province only one of eight Reference Sites in Europe to achieve this level. to cap the achievement, NI also received full marks against all five criteria.


medicines optimisation was one of the areas of good practice that was included in the reference site application and mOIc contributed significantly to the evidence regarding the medicines Optimisation component: medicines Optimisation in Older People (mOOP) in particular.


In line with transforming your care, the medicines Optimisation in Older People project has concentrated on the development of new consultant pharmacist-led models of care, with the focus being on patients admitted into intermediate care or residing in care homes.


Between 2012 and 2014, the western health and Social care trust (whSct) developed and evaluated an intermediate care case management medicines optimisation patient care pathway.


the aim of this work was to develop, implement and evaluate a consultant pharmacist-led case management pharmaceutical care service for older patients admitted to intermediate care (Ic) and continued back into the community setting.


Prior to project initiation in may 2012, a multidisciplinary process mapping event was held informing development of a new care pathway where the consultant pharmacist case


managed patients (≥ 65 years) throughout their stay in Ic and for at least 30 days post discharge.


On admission to Ic the consultant pharmacist reviewed the appropriateness of drugs prescribed using the medication appropriateness Index (maI), implemented patient- specific pharmaceutical care plans, and recorded/graded clinical interventions using Eadon criteria.


the pharmacist then contacted the gP and/or community pharmacist on discharge with direct case management continuing via post- discharge telephone calls and home visits. cost savings as a result of these interventions which prevent medication errors/adverse drug Events (adEs) were then estimated by the University of Sheffield School of health and Related Research (SchaRR).


drugs stopped/started were costed using the NhS dictionary of medicines and devices (dm & d) and the data collected was entered into SPSS v21 for analysis. the results were significant.


all older patients (n=453, aged 82.8±7.1yrs) admitted from acute to Ic care over a twelve-month period (july 2012 to june 2013) were case managed. three hundred and fifty-


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