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Medicines Management



Rhian Newton
Lynwen Jones
Definition of MM
‘encompasses the entire way in
 which medicines are selected,
 procured, delivered, prescribed,
 administered and reviewed to
 optimise the contribution that
 medicines make to producing
 informed and desired outcomes of
 patient care’
Cost of Prescribing in Swansea

• April 07 – March 08 - £36.8m
• All medicines (tablets, liquids,
  dressings, appliances)
• Approx. £150/head of population
• Estimate £3m wasted – over ordering,
  over prescribing, side effects,
• Everyone’s money
Who Manages this Money?

• 35 GP practices
• Each has a GP prescribing lead
• LHB Medicines Management Team
  (MMT) –
  8 pharmacists (full, part-time, sessional)
  6 technicians (full and part time)
  1 admin support
How is the money managed?
• Role of MMT - ‘ensure safe, cost
  effective, evidence based prescribing in
  line with NICE guidance and NSF’s,
  whilst minimising waste and without
  detriment to patient care.

• GP leads – ensure that prescribing
  messages are implemented in practice.
 NSF for Older People
• Use of medicines is fundamental in many
  of the standards.
• 4 in 5 people >75yrs take at least 1
  prescribed medicine, 36% take 4+
• ADRs implicated in 5-17% hospital
  admissions, and whilst in hospital 6-17%
  older people experience an ADR
• 50% don’t take medicines as intended
Medication Review – What is it?
Structured, critical examination of patients
medication (prescribed and purchased) –
• Reach an agreement with patient about
• Optimise impact of medicines
• Minimise medication related problems
• Reduce waste
- why is it important in Older People?

• Identifies polypharmacy, ADR’s, side effects,
• Identifies those at risk of falls
• Confirms treatments are still needed
• Ensures dosage instructions are listed
• Identifies items not being taken
• Ensures appropriate monitoring is carried out
• Offers patients the opportunity to be involved in
  their care
• Aids concordance
- who should be targeted?
• Taking 4+ medicines
• Patients with recent changes to medication
• Patients taking specific drugs e.g.
  warfarin,NSAIDs, anti-diabetics,diuretics,
• Recent discharge from hospital
• Unsupervised OTCs
• Patients with mental illness
• Patients in care homes
Risk of Falls
• ↑ age, illness = ↑ risk
• 4+ meds = ↑ risk
• Type of meds = ↑ risk
  e.g. hypnotics, antipsyh, diuretics,

Consequence – loss of confidence,
anxiety, depression, ↓ mobility, #, pain
long term Care Home, death
 Levels in medication review
                                                         Level 3
                 Technical        Level 2
                 review of                               review
                 patients meds   Treatment
                  Level 1                                Face to face

                                                         review of meds
                                                         + conditions

                                   Review of meds
Level 0                            with patients full

Ad Hoc
 Level 0: Ad Hoc Review
• What: takes place without access to the patient's
  clinical notes and does not have to include a review
  of the full repeat prescription.

• Who: Care Managers, Community pharmacists,
  member of practice staff, practice support pharmacist
  or technician, audit assistant, GP.

• Examples of interventions: supply problems, drug
  presentation issues, compliance, over stocks.

• Issues: Reviews can be helpful in identifying
  anomalies and highlighting patients who may need
  further medication review.
• What medicines are you taking?
• Why are you taking these medicines and
  what are the consequences of not taking?
• How long have you been taking them?
• How do you take these medicines?
• Do you buy any medicines?
• Do you have any concerns about your
• Do you think you need support with your
Practical Aspects
• Do you have any problems
  ordering/receiving medication?
• Do you have any problems removing
  medicines from their containers?
• Do you have any problems swallowing
  your tablets?
• Do you have any difficulty reading the
• Do you have any problems remembering
  to take your tablets?
• Community Pharmacist – assessment
  under DDA, ?MUR
• LHB team:
  Technician - review meds in patients
  Pharmacist – clinical review
• GP
 Swansea Unified Assessment
      and SSIA Project
3.4 - ‘Do you take any medication at the
       moment? If so, what is it and how
       do you manage it?’

What problems, if any, are encountered
with this question and how can we
work together to help overcome them?

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