TORFAEN MEDICATION ADMINISTRATION SCHEME

1. TORFAEN MEDICATION ADMINISTRATION SCHEME Val Bessell Wendy Tyler-Batt

2. Background • Care staff instructed to prompt only • Reality – administration to help out • No approval or support if problem arose • Medication: Health or Social Care Task?

3. Background • Wanless report: • Balance of care skewed towards secondary care ie too many people in hospital • TMAS was a logical development • Administration of medication by carers to help vulnerable adults remain in their own homes

4. In the beginning • TMAS started in May 2005 – with Wanless funding • Just with TSS carers • Medication Policy • Medication Training

5. Extension to other Care Providers • Scheme securely established with the in-house service providers • Training extended to the four block contract external providers • Opportunity to be a part of the scheme eventually extended to spot providers

6. Medication Administration Training • Over 340 carers have received training • Course has received OCN approval • Refresher Courses offered

7. Making Best Use of Medicines • ‘The costs associated with waste medicines are not just financial. There is also a cost to patients: effective use of prescribed medicines delivers improved health outcomes for patients, which may be foregone if medicines are not used to best effect.’ * * Kings Fund DOH report July 2011

8. NICE CG076 Medicines AdherenceCost statement • £8.1 billion Medicines on prescription cost in 2007–08. • If 50% of patients don’t take their medicines as recommended, this could mean that £4.0 billion of medicines are not used correctly. • Estimated costs of admissions resulting from the above between £36 million and £196 million in 2006–07. • These admissions and associated costs would be expected to decrease as medicines adherence increases.

9. NICE CG076 MEDICINES ADHERENCE • The current costs to the NHS associated with patients not adhering to prescribed medicines are large and the potential savings from reducing hospital admissions associated with non-adherence are also large.There is the potential to reduce the costs associated with non-adherence, perhaps by redirecting some of these resourcesinto additional training in consultation skills and interventions.’

10. Referral process • Generic referral form to HB pharmacist • Pharmaceutical Care Plan (PCP) = risk assesment • MAR chart & medication supplied

11. Referrals • Over 400 successful referrals to the scheme • Over 170 referrals on the scheme now • Multiple Sources

12. Successful referral rate

13. Source of referrals

14. Progress • Development of TMAS MAR chart • Extension to other care providers • All pharmacies in Torfaen participate • All GP practices in Torfaen • Increase in referrals • Decrease in processing time • Being used as example of good practice

15. TMAS • An excellent example of joint working across the health & social care interface • Referenced in ‘Pharmacy and Integrated Chronic Conditions Management in Wales’ • Paper published in Pharmacy Management journal

16. Funding • SHARED • Social Care – medication administration as part of integrated care package • Health Care • part time HB pharmacist • payment to community pharmacist to provide MAR chart

17. Hurdles to overcome • Communication and understanding • Between services in the community • Across the primary and secondary care interface • Continued funding of TMAS by Aneurin Bevan Health Board • Funding of medication only calls

18. Governance • Constantly looking at practice • Reviewing and making changes • Medication Policy updated & revised 2011

19. Conclusion • Improved Health & Social outcomes for the individual and society: • People remain in their own homes for longer • Staff are trained and more confident in their role • Medication administered as prescribed • More cost effective use of medication