1. Poster template by ResearchPosters.co.za Independent Pharmacist Prescriber Led Polypharmacy Clinics Pilot in Windsor, Ascot and Maidenhead CCG Melody Chapman, CCG Lead Pharmacist, Berkshire East Federated CCGs. (melody.chapman@nhs.net) INTRODUCTION Windsor, Ascot and Maidenhead CCG’s 5 Year Plan and Strategy-sets out the CCG’s key initiatives. Key initiative relating to medicines optimisation: to improve consistency of medicine prescribing with a particular focus on the reduction of polypharmacy. 1 Medicines Optimisation Team challenge: How to turn this vision into reality? Design a cost effective sustainable service Run a pilot Stakeholder agreement on aims of the service. AIMS HOW? WHO? Staff from practices (GPs, practice managers, nurses, reception staff). CCG Project Lead and CCG Project Manager. 3 independent pharmacist prescribers. And of course the patients! RESULTS Identified patients on 15 plus medications over the age of 75 years old and / or living in sheltered housing. Excluded those living in a care home & those requiring a domiciliary visit. (due to care home pharmacist in post & best use of pharmacist during the pilot). Invited patients to attend a review with a pharmacist. 30 minute consultation with pharmacist, telephone appointment, if requested. Referred to patient’s named GP as necessary. Patients provided with a written summary of discussion and amended medication re-order slip. Follow-up as required e.g. ordering of blood tests, referral to falls service, booking appointments and answers to clinical queries. Pilot scoped and developed by 3 CCG Lead Pharmacists and 2 CCG Project Managers. A clinic Standard Operating Procedure, patient information leaflet, patient letter and patient survey written. EMIS web polypharmacy search and consultation template developed RESULTS CONCLUSIONS DISCUSSIONS References Independent pharmacist prescribers can successfully run cost-effective polypharmacy clinics thereby sharing some of the GP’s workload. A comparable level of interventions actioned as per another investigator. 2 Plan to improve medication reviews carried out by all clinicians, via use of a bespoke EMIS medication review template based on NO-TEARS 3 Medication Reviews to be made a local prescribing indicator for 2015/2016. Shared learning from clinics to be taken to GP protected-time learning event. Awaiting figures for the reduction in the number of unplanned admissions. Savings made in terms of hospital admission or GP-time would be informative and desirable to calculate. Patient experience survey results pending, anecdotal feedback all excellent and verbal feedback from patients in the clinics also excellent. 1. Windsor, Ascot Maidenhead CCG. 5 year Plan and Strategy. Everyone Counts: thinking locally working together; 2014. 2. Zermansky AG, Petty DR, Raynor DK, Lowe CJ, Freemantle N, Vail A. Clinical medication review by a pharmacist of patients on repeat prescriptions in general practice: a randomised controlled trial. Health Technol Assess 2002; 6: 20. 3. Lewis T. Using the NO TEARS tool for medication review. BMJ; 2004; 329: 434 1.To reduce unplanned admissions due to preventable adverse drug reactions. 2.To help people to live at home safely. 3.To potentially reduce falls due to medication side effects. 4.To help people with long term conditions to manage their health and well-being. 5.To improve experience of health care services. 6.To reduce variation in the quality and value of prescribing. 7.To reduce problematic polypharmacy. 8.To support the ethos of integrated working. 9.To support the named GP. 10.To improve the quality of care for older people and those with complex needs I have more drugs in my cupboard than Boots In 2014 My drugs have been reviewed as they were concerned I was taking too many In 2019 V I S I O N WHEN? 3 months from 1.1.15 to 31.3.15 WHERE? 3 practices chosen with highest numbers of patients on 15-20 plus medicines and highest rates of patients living in sheltered accommodation. METHOD Letters Sent200 Sessions24 Patients Seen109 (7 telephone consultations) Did not attend1 Interventions483 Table 1:Clinic statistics Chart 1: Interventions ( n = 483) broken down by type Medication Savings£13,946 Medication Investment£6,261 Net Savings£7,685 Per Patient Savings£70.50 Table 3: Savings Per Annum Items stopped1.21 Quality intervention1.13 Side effect prompts change0.42 Table 3: Intervention per patient The pilot was a success, as it met the measurable aims and clinics are being rolled out for 2015.16. Aim 1: analysis results awaited. Aim 2: patients living in sheltered reviewed; reviewed medication for anti- cholinergic & CNS side effects, and acute kidney injury. Aim 3: reviewed medication for potential to cause falls, referrals to the community falls service, reviewed bisphosphonate prescribing. Aim 4: face-to-face contact time, counselling on medication, offered telephone appointments to those that could not attend. Aim 5: patient consultations with independent pharmacist prescribers. Aim 6: on average one quality intervention per patient, and average net savings Aim 7: 483 interventions Aim 8: effective working with GPs, practice nurses, practice managers and reception staff to support patients Aim 9: changes to patient medication, booking patients for outstanding QOF blood tests, amending care plans & medication reviews Aim 10: stopped medication causing side effect’s, ensuring medication monitoring, optimising doses, treating to national and local guidelines. Acknowledgments Other pharmacists involved in providing the polypharmacy clinics: Dawn Best, CCG Lead Pharmacist WAM CCG (dawnbest@nhs.net) and Tim Langran, CCG Lead Pharmacist Slough CCG (tim.langran@nhs.net)