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
Cost of Prescribing in Swansea
• April 07 – March 08 - £36.8m
• All medicines (tablets, liquids,
• 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
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
• Aids concordance
- who should be targeted?
• Taking 4+ medicines
• Patients with recent changes to medication
• Patients taking specific drugs e.g.
• 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
Technical Level 2
review of review
patients meds Treatment
Level 1 Face to face
review of meds
Review of meds
Level 0 with patients full
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
• Do you have any problems
• Do you have any problems removing
medicines from their containers?
• Do you have any problems swallowing
• 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
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?