Patient safety in the vein of medicines optimisation is being addressed in a breakthrough collaborative with the same intervention being applied across 5 sites in NWL (Chelsea and Westminster Hospital, West Middlesex Hospital, Charing Cross Hospital, St Marys Hospital and Hammersmith Hospital).
The ReMAC project aims to build resilience in older patients who have frailty through a sustained improvement in the delivery of consistent, high quality medicines optimisation to achieve better patient experience and outcomes in Northwest London.
The key interventions are multidisciplinary medication reviews with patients in acute care, and clearly documenting them to inform primary care. A comprehensive medication review includes a structured critical examination of all current medication with the objective of reaching an agreement with the patient about treatment. The reviewer systematically considers the merits and risks of different medications, stops inappropriate medicines and starts others optimising their impact, minimising the number of medication related problems and reducing waste.
We have developed a “bottom up” approach to formal training of junior pharmacists about medication review and “deprescribing” with inclusion in pharmacy undergraduate and postgraduate curricula at local universities. The views of junior doctors on deprescribing and medication review have been explored using surveys and the findings have been published and presented at a conference generating widespread interest.
Over the course of the project data analysed so far, we have maintained an improvement in the number of medication reviews that have taken place and have been clearly documented on the discharge summary. Medicines review is embedded as normal practice across all wards at Chelsea and Westminster hospital and is now normal practice in care of the elderly wards at West Middlesex, St Mary’s, Charing Cross and Hammersmith hospitals. At the start of the ReMAC project a very low level of patients had clearly documented medication reviews (lowest recorded 0% highest recorded 29% in any one week during baseline data collection), except at the Chelsea and Westminster hospital where the baseline average was c. 40%. During the course of the improvement project this increased to site averages ranging from 50% – 90% of patients.
We have undertaken a consensus building exercise involving experienced pharmacists and consultant physicians who have agreed on who to target for inpatient medication review and how the need for comprehensive or urgent action should be escalated. These interventions are to be embedded into clinical pharmacy practice in all participating hospitals.