MEDICINES USE AND SAFETY NETWORK EVENT: MARCH 2019 WHO Medication Without Harm Challenge: Tackling medicines safety challenges in transfer of care and adherence Barry Jubraj Professor Nina Barnett Medicines Use & Safety Network, Specialist Pharmacy Services www.sps.nhs.uk 14/03/2019 1
Upcoming MUS Events WEBINARS : Wednesday 10 April End of Life Care with Sara Bernstein THURSDAY 9 May Frailty with Lelly Oboh and Jennifer Stevenson Wednesday 12 Jun Transitions of Care in Mental Health with Caroline Dada FACE TO FACE EVENTS (London) 23/24 October MUSN Meeting The way we contact you will be changing so please register on our website: www.sps.nhs.uk; update your profile with your network choices from the Medicines Use & Safety Networks list; tick the box to opt in to receive updates and save your profile. Contact LNWH-tr.MUS-SpecialistPharmacyServices@nhs.net for any information about events or networks www.sps.nhs.uk 14/03/2019 2
9.30 Arrival, Registration and coffee Barry Jubraj 10:00 Welcome and Introductions and housekeeping Associate Director Medicines Use and Safety (MUS) Barry Jubraj & Nina Barnett 10.10 Medicines safety and non-adherence – making the link Consultant Pharmacist & MUS Welcome to : Dr Christina Jackson 10.25 Is it any better? The ongoing challenge of non-adherence King’s College London • Our 11.10 Coffee and networking participants Barry Jubraj/Nina Barnett/ 11.40 Medicines safety and non-adherence workshop Christina Jackson • 12.30 Lunch and networking – a sandwich lunch will be provided Nina Transfer of care (ToC) and medicines – Context setting & 13.30 Nina Barnett Barnett recent webinar 13.35 ToC – A patient’s experience Nigel Westwood 14.00 ToC and care homes – the Sutton experience Hai To, Sutton CCG, Surrey • Our 14.30 Break and networking speakers Jacqui Ballantyne and Amy ToC in community paediatrics and insulin management (two 15.00 Bradley. Northumbria presentations) Healthcare 15.40 Panel Q&A All Presenters 16.15 Take away messages Barry Jubraj/Nina Barnett 16.30 SPS update and close Barry Jubraj www.sps.nhs.uk 14/03/2019 3
Session 1: Medicines safety and non-adherence – making the link A 15-MINUTE CHAT • What we are trying to do • Why we think it is important • How this chat leads into the rest of the morning • Outcomes • Starting points: • What is medicines adherence? • What is medication safety? www.sps.nhs.uk 14/03/2019 4
• Medication safety is defined as freedom from preventable harm with medication use • (Canadian Patient Safety Institute 1 ). • So it’s more than just error reporting • Adherence to medicines is defined as the extent to which the patient's action matches the agreed recommendations • (NICE 2 ) • Christina’s talk (next) will give a fuller definition 1. Medication Safety. Canadian Patient Safety Institute: https://www.patientsafetyinstitute.ca/en/Topic/Pages/Medication-Safety.aspx (accessed 11.3.19) 2. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence . NICE: https://www.nice.org.uk/guidance/cg76/chapter/introduction (accessed 11.3.19) www.sps.nhs.uk 14/03/2019 5
Any evidence for a link between safety & non-adherence? • Brighton/King’s: The PRIME Study - develop a risk prediction model that identifies older adults most at risk of experiencing medication-related harm after discharge from hospital: • Stevenson J, Parekh N, Ali K, Timeyin J, Bremner S, Van Der CammenT, et al. Protocol for a Prospective (P) study to develop a model to stratify the risk (RI) of medication (M) related harm in hospitalized elderly (E) patients in the UK (The PRIME study). BMC Geriatr 2016;16:22 www.sps.nhs.uk 14/03/2019 6
• Recent meta-analysis: clear relationship between mortality and polypharmacy: • Leelakanok N, Holcombe AL, Lund BC, Gu X, Schweizer ML. Association between polypharmacy and death: A systematic review and meta- analysis. J Am Pharm Assoc 2017;57:729 – 738 • Sub-study of PRIME looked at this relationship – could it be due to side effects? Or non-adherence? www.sps.nhs.uk 14/03/2019 7
Findings: • 1280 patients recruited • 413 experienced medication-related harm (MRH) • 93 cases harm at least partly explained by non-adherence • Multivariable analysis: MRH due to non-adherence was associated with one-year all-cause mortality. MRH due to ADR was not Harm from non-adherence to medications may explain the relationship between polypharmacy and mortality www.sps.nhs.uk 14/03/2019 8
Questions for us all to think about: 1. ‘Missed dose’ audits in hospitals are typically badged under ‘medication safety’ • But non- adherence generally isn’t. Why ? 2. When we start a medicine, we evaluate risks, e.g. allergies, side effects, interactions • Do we evaluate the risk of non-adherence? 3. We sometimes use a risk matrix to think about safety • Could this work with non-adherence? www.sps.nhs.uk 14/03/2019 9
www.sps.nhs.uk 14/03/2019 10
TWO PATIENT STORIES www.sps.nhs.uk 14/03/2019 11
What we are trying to do • Get us thinking – starting today, about medicines non- adherence in safety terms Why we think it is important • Non-adherence described as esoteric or somehow less important than ‘medication safety’. It IS part of medication safety How this chat leads into the rest of the morning • Christina’s talk made the two of us sit up and think – so we wanted you to hear it Outcomes • Workshop later, collect your thoughts, then publish www.sps.nhs.uk 14/03/2019 12
SUMMARY THEN SESSION 2: OVER TO CHRISTINA www.sps.nhs.uk 14/03/2019 13
SESSION 3 www.sps.nhs.uk 14/03/2019 14
Session 3: Medicines safety and non-adherence RAPID workshop Aim: To discuss the key questions from the first session How: 1. Three groups of 30-ish go to different parts of the room 2. Thirty becomes 3 x 10-ish 3. Each group of 10 rotates round three flipcharts with the earlier questions on each chart - 8 minutes per chart 4. Use post it notes to discuss and put up thoughts 5. Nina, Christina, Barry each buddy with a group of 30 then debrief www.sps.nhs.uk 14/03/2019 15
Questions: 1. ‘Missed dose’ audits in hospitals are typically badged under ‘medication safety’ • But non- adherence generally isn’t. Why ? 2. When we start a medicine, we evaluate risks, e.g. allergies, side effects, interactions • Do we evaluate the risk of non-adherence? 3. We sometimes use a risk matrix to think about safety • Could this work with non-adherence? www.sps.nhs.uk 14/03/2019 16
9.30 Arrival, Registration and coffee Barry Jubraj 10:00 Welcome and Introductions and housekeeping Associate Director Medicines Use and Safety (MUS) Barry Jubraj & Nina Barnett 10.10 Medicines safety and non-adherence – making the link Consultant Pharmacist & MUS Review Dr Christina Jackson 10.25 Is it any better? The ongoing challenge of non-adherence King’s College London 11.10 Coffee and networking Barry Jubraj/Nina Barnett/ 11.40 Medicines safety and non-adherence workshop Christina Jackson 12.30 Lunch and networking – a sandwich lunch will be provided Transfer of care (ToC) and medicines – Context setting & 13.30 Nina Barnett recent webinar 13.35 ToC – A patient’s experience Nigel Westwood 14.00 ToC and care homes – the Sutton experience Hai To, Sutton CCG, Surrey 14.30 Break and networking Jacqui Ballantyne and Amy ToC in community paediatrics and insulin management (two 15.00 Bradley. Northumbria presentations) Healthcare 15.40 Panel Q&A All Presenters 16.15 Take away messages Barry Jubraj/Nina Barnett 16.30 SPS update and close Barry Jubraj www.sps.nhs.uk 14/03/2019 17
Upcoming MUS Events WEBINARS : Wednesday 10 April End of Life Care with Sara Bernstein THURSDAY 9 May Frailty with Lelly Oboh and Jennifer Stevenson Wednesday 12 Jun Transitions of Care in Mental Health with Caroline Dada FACE TO FACE EVENTS (London) 23/24 October MUSN Meeting The way we contact you will be changing so please register on our website: www.sps.nhs.uk; update your profile with your network choices from the Medicines Use & Safety Networks list; tick the box to opt in to receive updates and save your profile. Contact LNWH-tr.MUS-SpecialistPharmacyServices@nhs.net for any information about events or networks 14/03/2019 18
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