Medicines Management: High Quality Care for All

1. PRESCRIBING AND RESEARCH IN MEDICINES MANAGEMENT:“High quality care for all, now and for future generations” Dr David Gerrett Senior Pharmacist NHS England Patient Safety

2. 2000, >15 years ago! Slide 2PRiMM 29th January 2016 London

3. Our overriding aim is to embed a culture of safety in all NHS treatment, whether in hospitals or in primary care. Ensuring that drug treatment is safe is central to this strategy. The rates of administration errors in primary care and community healthcare settings are not known. Department of Health (2004). Building a safer NHS for patients: Improving medication safety. A report by the Chief Pharmaceutical Officer. London: Department of Health. Also available at: www.doh.gov.uk/buildsafenhs/medicationsafety/medicationsafety.pdf (January 2004) Slide 3PRiMM 29th January 2016 London

4. Medication errors are incidents in which there has been an error in the process of prescribing, dispensing, preparing, administering, monitoring, or providing medicine advice, regardless of whether any harm occurred. (NPSA 2007) We also need to consider: …latent errors (or latent conditions), refers to less apparent failures of organisation or design that contributed to the occurrence of errors or allowed them to cause harm or Latent failure conditions describe the set of background circumstances which eventually lead to an unsafe act. National Patient Safety Agency. Safety in doses: medication safety incidents in the NHS 2007 http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=61392 Slide 4PRiMM 29th January 2016 London

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6. Routine Reasoned Reckless & Malicious Basic error types Violations Rule & Knowledge Based errors Mistakes Lapses Slips PSIs Intended actions Unsafe acts Skill based errors Memory failures Skill based errors Attentional failures Unintended actions Slide 6PRiMM 29th January 2016 London

7. Competence Consciously incompetent Assess and learn PSDA Learn Consciously competent Unconsciously incompetent Practice Lapse Unconsciously competent The implications: we are all capable of error and things change NPC. MeReCbulletin.2011;22(no1) http://www.npc.nhs.uk/merec/mastery/mast3/resources/merec_bulletin_vol22_no1.pdf Slide 7PRiMM 29th January 2016 London

8. Improved patient outcomes Medicines Optimisation Principles Aim to understand the patient’s experience Evidence based choice of medicines Aligned measurement & monitoring of medicines optimisation Patient-centered approach Make medicines optimisation part of routine practice Ensure medicines use is as safe as possible All centred around measurement/metrics and outcomes Slide 8PRiMM 29th January 2016 London

9. The goal of Medicines Optimisation • Medicines optimisation looks beyond the cost of medicines to the value they deliver and recognises medicines as an investment in patient outcomes. • The goal of MO is to help patients to: • Improve their outcomes, including better monitoring and metrics • Have access to an evidence-based choice of medicine • Improve adherence and take their medicines correctly • Avoid taking unnecessary medicines • Reduce wastage of medicines • And improve medicines safety Slide 9PRiMM 29th January 2016 London

10. MO - the Dashboard http://www.england.nhs.uk/2014/06/12/mo-dash/ Slide 10PRiMM 29th January 2016 London

11. Proportion of Harm Total number of medication incidents reporting harm Total number of medication incidents The new metric provides an indication of preventable harms occurring and a surrogate measure of reporting culture Better reporting and learning, especially of no harm incidents, will help to enable action to minimise preventable harms from medicines Takes specific information from the NRLS and presents it in the MO dashboard Slide 11PRiMM 29th January 2016 London

12. Use of safety Audit Software within CCGs GP practices using PINCER Slide 12PRiMM 29th January 2016 London

13. Medical Device Safety Officer Slide 13PRiMM 29th January 2016 London

14. Supporting documents Slide 14PRiMM 29th January 2016 London

15. And coming up – implementation of…. Article 107a(5)of Directive 2001/83/EC outlines the key responsibilities of national competent authorities (MHRA) in relation to the reporting of ADRs associated with medication error: • Member States shall ensure that reports of suspected adverse reactions arising from an error associated with the use of a medicinal product that are brought to their attention are made available to the Eudravigilance database and to any authorities, bodies, organisations and/or institutions, responsible for patient safety within that Member State. They shall also ensure that the authorities responsible for medicinal products within that Member State are informed of any suspected adversereactions brought to the attention of any other authority within that Member State. These reports shall be appropriately identified in the forms referred to in Article 25 of Regulation (EC) No 726/2004. Slide 15PRiMM 29th January 2016 London

16. ADE’s, ADR’s and Medication Errors THE FOCUS Preventable (ADEs, ADRs and AEs) NHS E No harm Low harm Things we don’t know NHS E Medication errors ADE’s Non preventable (ADR, MHRA) Potential ADE’s Intercepted NHS E Bates DW, Boyle DL, Vander Vliet MB, Schneida J, leape L. Relationship between medication errors and adverse drug events. J. Gen. Intern. Med, 1995;10:199-205. Slide 16PRiMM 29th January 2016 London

17. ADE’s, ADR’s and Medication Errors THE FOCUS Preventable (ADEs, ADRs and AEs) NHS E, MHRA No harm Low harm Things we don’t know NHS E Medication errors ADE’s Non preventable Potential ADE’s Intercepted NHS E Slide 17PRiMM 29th January 2016 London

18. ADE’s, ADR’s and Medication Errors THE FOCUS Preventable (ADEs, ADRs and AEs) NHS E, MHRA No harm NOT MHRA Low harm Things we don’t know NHS E Medication errors But NOT NHS E, ‘pure’ ADR Potential ADE’s Intercepted NHS E But NOT MHRA Slide 18PRiMM 29th January 2016 London

19. Total Patient Safety Incidents NRLS for March 2014 Extraction month Slide 19PRiMM 29th January 2016 London

20. In 2014 the absolute number of medication reports to the NRLS increased more than in any previous year, representing a 15.6% increase on the year before. Slide 20PRiMM 29th January 2016 London

21. From the January 2016 CAS dataset Slide 21PRiMM 29th January 2016 London

22. Future Developments • MSO Network going from strength-to-strength • Clinical Pharmacists in GP practices (many could be MSOs) • Medicines Optimisation embedded into the ‘Right Care’ programme, which looks to identify and embed best practice www.rightcare.nhs.uk Slide 22PRiMM 29th January 2016 London

23. 1 key objective + 3 key phases + 5 key ingredients = COMMISSIONING FOR VALUE OBJECTIVE - Maximise Value (individual and population) • Five Key Ingredients: • Clinical Leadership • Indicative Data • Clinical Engagement • Evidential Data • Effective processes 23 Slide 23PRiMM 29th January 2016 London

24. The patient safety vision Black box Slide 24PRiMM 29th January 2016 London

25. To Summarise the MSO role, to: • gather evidence of a local learning culture • incrementally improve reporting and learning • implement better, safer medication practice locally and nationally • work together as discrete groups on common topics • be the formal conduit between NHS England Patient Safety and practice for medication safety issues National Learning practice Slide 25PRiMM 29th January 2016 London

26. To focus the role - Most importantly implement better, safer medication practice locally and nationally Implement local system safety improvements and be able to prove it National Learning VISION MSOs Slide 26PRiMM 29th January 2016 London

27. Questions (15 minutes, or less?) Many thanks for your time David.Gerrett@nhs.net Slide 27PRiMM 29th January 2016 London