Mike Scott`s Presentation

European Innovation
Partnership on Active and
Healthy Ageing
Medicines Optimisation
Best Practice
Professor Mike Scott
Pharmacy and Medicines Management
Northern Health and Social Care Trust
Titanic Centre
30th January 2014 Belfast
Time line
2000-2004 Integrated Medicines Management
(IMM)-patients over 65 years of age
2005-present Pharmaceutical Clinical
2006 - Safer Patient Initiative (International
Healthcare Improvement (IHI) )
2010- present Innovation Programme
How was it initiated
 Business
case was produced indicating
the work that was proposed
 Resources required to undertake
 Process measures
 Clear outcome measures
 Research base methodology
How Was Political Support
 Northern
Ireland Executive Innovation
Fund proposal (1999)
 Citizen
Benefits for older people
predicated on previous local evidence
How was financial support
Executive programme funds Euro 720k first three
years for the pilot
Based on positive outcomes further investment
over the next five years Euro 4.8million
Return on Investment:
For very 3 euro invested per head of population
15 Euro returned
Innovation programme 840k Euro
Stakeholder Buy -in
All relevant stakeholders were involved at the
Integration of the key healthcare team
In the Pharmaceutical Clinical Effectiveness
Programme there is a multidisciplinary
collaborative approach to reach consensus
on clinical products based on safety and
Implementation of the technical
Comprehensive education and training
Integration with medical and nursing colleagues in
both primary and secondary care
Standard operating procedure development
Documentation development
Skill mix and role clarity
Software development for both operational use
and process and outcome capture
Robust research based methodology-University
How change management was
 Extensive
pre implementation discussion
with all key stakeholder groups
 Workshops and presentations
 Roadshows
 Oversight group
 Operational group
 To
optimise the benefits that patients gain
from prescribed treatments through
innovative technology-supported solutions
delivered through intra professional and
intra sectoral systems change
Medicine Optimisation Objectives
Right Drug
Matrix methodology
STEPSelect (Safe Therapeutic Economic
Pharmaceutical Selection) optimise acquisition
Formulary management
Guideline development
Medicine Optimisation Objectives
Right Patient
Re-engineered clinical pharmacy services in
the hospital setting (older patients)(EPICSElectronic Pharmacist Clinical Intervention
 Focus on admission ,inpatient stay and
 Medicines appropriateness index
 Consultant care of the elderly pharmacists in
intermediate and nursing home settings
 Predictive risk modelling in the elderly
Medicine Optimisation Objectives
Right Dose
 Medicines
reconciliation between sectors
(Writemed software)
 Medicines reconciliation between
 Medicines reconciliation at all transitions of
 Development of the Emergency Care
Summary(ECS) and then Emergency Care
Medicine Optimisation Objectives
Right Time
to EIP –AHA to improve
adherence to prescribed treatments
 HSC assessment tools
 Adherence solutions both technological
and patient focussed
 e -health strategy
 Development of a technology supported
intervention via the Small Business
Research Initiative(SBRI)
 Commitment
Results (1)
Reduced length of stay by 2 days
Reduced readmission rate
Reduced length of stay on readmission 5.8 days
Improved Medicines Appropriateness Index (17.48
to 5.69)
Reduction in 4.2 errors per admission kardex
Reduced medicines administration error rate(8.3%
to 1.3%)
Reduced discharge error rate from 22% to less
than 1%
Results (2)
Nursing home:
 Four interventions per patient
 Improved MAI
 Reduced costs of £48 per month per patient
 Reduced ED attendances
 PCE programme achieved 168 million Euro
of efficiency gains
 Improved satisfaction with the system by
Added Value-Integrated working
 Enhanced
 Between health care professionals
 Between sectors
 Between community and voluntary sectors
 Traditional barriers broken down
Efficiency Effectiveness
211 pharmacists and technicians have been trained across
Northern Trust has a multi faceted adherence service
Software developments have improved the efficiency and
In place for 13 years
Adoption in other countries
Learning visits testify to the recognition of the effectiveness
and efficiency
Competitiveness Market Growth
STEPSelect - Digitalis Ltd Amsterdam
EPICS(Electronic Pharmacist Clinical Intervention
System) –Yarra Software Ltd Belfast
Writemed (Medicines reconciliation software
programme) -Yarra Software Ltd Belfast
Bespoke locker development -Hospital Metalcraft
Competitiveness,Market Growth
Clinical rules –Digitalis and Orbisch Medisch Centrum
Sittard Netherlands
Intelligent Alerts - Yarra Software Ltd Belfast
Local Automated Microbiology Pharmacy Surveillance
System (LAMPS) Yarra Software Ltd Belfast
Other HCAI related , Iskus Health- Dublin,Arran
Healthcare –Dublin, Goldshield- USA
Success factors(1)
 Early
stakeholder engagement
 Willingness
to change systems and
 Good
strategic and operational oversight
Success Factors (2)
 Robust
methodology in terms of both clear
process measures and outcomes
 On-going reports and dissemination of
progress including conferences and
 Development of enabling technologies
 Quality improvement model of change
Success Factors (3)
Better engagement with researchers
 Better values and outcomes though
engagement with Pharma
 Concordance improvement though
partnerships with patients and carers
 Improved dialogue with the technology
 Utilisation of Government innovation
incentives in pursuit of the health and well
being agenda
Barriers to innovation
 Underdeveloped
pharmacy service
focussing on distribution rather than
patient facing
 Lack of awareness of current system
deficiencies by other healthcare
colleagues and the skill set of pharmacy
 Lack of technical staff
 Absence of training material
 Enabling technologies
Transfer Success
 Another
Trust in Northern Ireland
 Regional in Northern Ireland
 Numerous Trusts in England
 Uppsala in Sweden
 Skane in Sweden
 Tallaght Hospital in Southern Ireland
 Drogheda Hospital In Southern Ireland
Education and Training
Colleagues from
South of Ireland
Erasmus programme with Poland
Programme with the Spanish Hospital Pharmacists
Exchange programme with Orbisch Medisch Centrum
Sittard ,Netherlandss
Numerous visits from English Colleagues
New Zealand
Lessons Learnt
Realistic timelines
 Full stakeholder engagement and ownership
 Ensure that robust measures are determined
at the outset
 Awareness of the difficulties in developing
enabling technologies from both a hardware
and software viewpoint
 The importance of ensuring paper based
methods work before automating
 Identifying commercial partners
Action Plan(A1) Prescription and
Adherence to Medical Plans
 Improve
patient adherence to care plans
 Empower patients and caregivers
 Deliver improvements in the healthcare
system to promote adherence
 Contribute to the research methodology on
ageing and adherence
 Foster communication between different
partners to improve adherence
Work to date
 Delivered
transferrable process changes
in hospital and interface aspects
 Delivered enabling technologies with EU
 Delivered robust evidence
 Delivered enhanced communication
between key partners at transitions of care
 Initiated work on older patients in cohorted
settings in the community
Medicines Management
Support Service Project
 To
improve outcomes form prescribed
medicines by ensuring safety and quality
in provision of adherence support for older
people who are living in their own homes
and SEHSCT ,Community
Medicines Management
Support Service Project
 Develop
a referral mechanism
 Refine the assessment tool
 To identify a range of solutions
 Explore feasibility of monitoring and followup
 Develop governance arrangements
 Problems –access,concordance,clinical
Small Business Research
Initiative (SBRI)
For individual use
For the use of people living in their own homes
Tailored to the individual’s needs
Easy to use
Supported by monitoring and data tracking
Capable of incorporation into patient care
Capable of interface with HSC ICT systems
Valuable potential collaborators to complete
the gap closure
 Enables awareness of other work and a
much more cohesive way to go forward
 Building of links with other groups in your
specific area via EIP members
 Dissemination mechanism
 Formulate research questions
 Bids for Horizon 2020 funding
mail :
 [email protected] trust.hscni.net

similar documents