Medicines management in nursingPosted on: November 10, 2021
by David Diaz
In 2019/20, NHS England spent a reported £20.9 billion on medicines – their second-highest cost after staffing. Their reports into medicine use indicate that one quarter of the UK’s population has a long-term health condition, with one quarter of people over 60 having two or more long-term health conditions. The majority of these conditions require medication for ongoing management.
Furthermore, our ageing population requires increased use of multiple medicines, known as polypharmacy. But it’s not simply the amount of medicines that cause an issue; our health service faces increasing pressure regarding their use. Statistics compiled by the NHS and Provide indicate that:
- Between 5-10% of all hospital admissions are medicines-related
- Two-thirds of medicines-related hospital admissions are preventable
- Up to 50% of patients do not take the medicines they have been prescribed
- An estimated £150 million of medicines are wasted unnecessarily within the NHS
- Between 30-50% of medicines prescribed for long-term conditions are not taken as intended
When used correctly, medicines have the capacity to effectively prevent, treat or manage a wide variety of illnesses and conditions – making them the most common therapeutic intervention within healthcare. However, stringent and efficient management is required in order to minimise the extent of issues currently encountered.
What is medicines management and why is it important?
According to the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA), medicines management refers to “the clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit from the medicines they need, while at the same time minimising potential harm. It’s a system of interconnected processes and behaviours that determine how medicines are used by NHS patients. And, as indicated, there are stark costs to getting it wrong.
Patients, with ongoing support from clinicians, need to receive the appropriate choice of medicines at the appropriate time. The goals for effective use of medicines are patient-focused, aiming to:
- Improve patient outcomes and satisfaction
- Support patients to take medicines correctly
- Avoid patients taking unnecessary medicines
- Reduce wastage of personal medicines
- Improve the safety of medicines for patients
- Support the delivery of clinical governance
As well as working towards better health outcomes, effective prescribing and medicines management allows patients to take charge of their own health, providing both autonomy and empowerment.
Effective medicines management in healthcare settings
Currently, Clinical Commissioning Group (CCG) Medicines Optimisation (MO) teams are tasked with implementing and overseeing medicine use. Their function, across the system, includes medicines commissioning and procurement, medicines finance, and medicines safety and quality.
MO teams are primarily comprised of pharmacists and pharmacy technicians – both registered professions regulated by the General Pharmaceutical Council. Among their many responsibilities, MO teams:
- Provide up-to-date, unbiased information about medicines and treatment pathways
- Support practitioners and patients
- Develop local and practical guidance to support administration of medicines, prescribing practices, storage and secure handling of medicines and medication reviews
- Promote the safe and evidence-based use of medicines
- Ensure that patients with specific characteristics receive tailored treatment plans
- Communicate with hospitals
Pharmacists play an important role within health infrastructure that goes far beyond prescribing. Within primary care settings – such as hospitals, GP practices and community pharmacies – pharmacists can support other healthcare professionals with advice and information about medicines they may be less familiar with. They are also well placed to forge links between primary and secondary care settings, and advise on medicines optimisation and management.
In this way, information extends across numerous other settings – from social care, such as care homes, to mental health services for young people. For example, the successful roll-out and uptake of vaccinations throughout the coronavirus pandemic relied on clear guidelines, safety measures and monitoring, made possible by close collaboration across healthcare settings.
The principles of modern medicines management
The Royal Pharmaceutical Society (RPS) published guidance for healthcare professionals, titled ‘Medicines Optimisation: Helping patients to make the most of medicines’. The guidance is separated into four overarching principles:
- Principle 1 – Aim to understand the patient’s experience. In order to ensure that medicines are used optimally, the guidelines stipulate the need for ongoing, open dialogue with patients. This should include information about the options available to them and their experiences with managing their condition with medication. Where a patient cannot engage with their treatment plan – e.g. if they are too young or have a learning disability – relevant carers should be involved.
- Principle 2 – Evidence-based choice of medicines. Practitioners must ensure that any decisions regarding medicines are grounded in clinical evidence, cost-effective, and best meet the needs of the patient. Consulting an appropriate formulary plays an important role.
- Principle 3 – Ensure medicines use is as safe as possible. Safety of medicines includes all aspects of their usage, including: unwanted effects; interactions; safe processes and systems; and communication between professionals. It’s not just prescribers who are responsible for safe medicine use; all health professionals, healthcare organisations and patients should ensure best practice is adhered to.
- Principle 4 – Make medicines optimisations part of routine practice. This guideline requires health professionals to routinely discuss how to obtain the best outcomes from medicines. These discussions should involve any relevant care provider and the patient/carer, and must span the course of the treatment.
The principles aim to maximise high quality care and share expertise in relation to medicines and medication. They provide a framework to empower patients and professionals, guide decision making towards best possible outcomes, increase patient safety and enable medicine monitoring. Best practice will also support the NHS to reduce wastage and save money.
Help patients to receive the best possible healthcare
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