I was fortunate to have a long train journey this month to thoroughly read my recent Pharmaceutical Journal (Feb 2019 Vol 302 (7922)). The journal was a special with a focus on Medicines Safety. As a Non-Executive Director for the EMAHSN, two articles resonated with me. ‘GP pharmacists leading the way’ – with a spotlight on PINCER and ‘Train not Blame’, giving background to EPIFFANY. You can read the Journal article here.
Here in our region we are fortunate to have been early adopters of these two innovations.
PINCER – is the ‘Pharmacist-led INformation technology intervention for reducing Clinically important ERrors in medication management’, developed through collaboration between Nottingham and Manchester universities.
In the East Midlands, it has been rolled out to 370 GP practices since September 2015. Over 2.9 million patient records have been searched, identifying over 21,000 instances of hazardous prescribing. Analysing trends from data collected, as part of the evaluation of the rollout, it is estimated that over 10,500 patients have received an active intervention resulting in safer care as a direct benefit of implementing the intervention.
Within the AHSN network emphasis is now on the national adoption and spread of innovative programmes, that have been demonstrated regionally to be effective. PINCER is now one of the seven national programmes ready to be adopted across the AHSN network. PINCER sits within the Medicines Optimisation project with targets set for 2018-2020. It is anticipated that nationally PINCER will reflect the initial outcomes seen with fewer medication-related hospital admissions and resulting in a reduction in cost to the NHS.
This year, within Nottinghamshire we are excited to have been part of a pilot of 13 new PINCER National Indicators alongside new software models. All six Nottinghamshire CCGs have now received training in the PINCER intervention and the new methods of data extraction and uploading. The pilot has been well-received and there are plans to roll-out the new indicators and software as part of the PINCER intervention across other CCGs in the East Midlands. Developing the new National Indicators and PINCER software based on user feedback will enable the programme to fully meet the needs of clinicians and enhance the adoption and spread of the programme.
The Journal also shared the learnings from the introduction of ‘EPIFFANY’ to the Wrightington, Wigan and Leigh NHS Foundation Trust, as one part of an initiative to improve medicines incident reporting. The EPIFFANY project (Effective Performance Insight for the Future) – was developed at the University Hospitals of Leicester NHS Trust by Rakesh Patel, in conjunction with the University of Leicester. It is an ‘insight and awareness raising’ approach to educating healthcare professionals such as junior doctors. This programme aims to increase the skills, knowledge and competence of junior doctors to help support improvements to prescribing. It comprises four teaching components, including real patient simulations and feedback from clinicians. Recent data shows that there is a 50% performance increase, with the same performance improvement maintained over 12 months for junior doctors. The project further developed links between the junior prescribing doctor and a lead pharmacist – ensuring medicines safety is co-produced within the hospital. As one of the projects in the EMAHSN portfolio, we continue to support the University of Leicester to develop a sustainable model of the programme – in order to enable further adoption.
Medicines safety forms a significant strand within the EMAHSN portfolio for 2018-2020. The NHS spends over £16.8 billion on medicines and it is anticipated that this will grow to £20 billion in the next five years. Within the AHSN medicines optimisation national programme the Transfer of care of Medicines (TCAM) is a central tenet. The need for TCAM arises when patients leave hospital and may be in need of extra support when taking their prescribed medicines, as these may have changed. We are working with four of our Acute Trusts within the East Midlands to record TCAM referrals and completions by community pharmacists using PharmOutcomes software. We also have engagement from all other trusts to adopt and upgrade systems in order to offer this service to community pharmacists and their patients.
Well done Pharmaceutical Journal for an excellent Infographic and for summarising the new initiatives in Patient Safety. A pleasure to see how small innovative steps taken by the EMAHSN are gaining momentum across the East Midlands Region and beyond.
To learn more about the work we are doing in the area of medicines optimisation (MO), visit our dedicated MO webpages.
Author
Dr Janet Worrell - Independent Director
Janet is a director at a consultancy firm specialising in creative clinical and regulatory solutions for healthcare and bioscience sectors.