PM Healthcare - Summer 2022

20 PM Healthcare Journal PM Healthcare Journal 21 Medicines Optimisation team at NHS Arden & GEM CSU (Arden & GEM) was tasked with working alongside key stakeholders to accelerate the uptake of DMS across the system. We utilised the concept of Genchi Genbutsu to understand potential issues or barriers through being at the location of the process. 13 We believed this approach would enable us to tailor our solutions for implementation and accurately direct resources. When implementing any new service or change to practice, we follow a structured approach which is underpinned by effective stakeholder engagement and robust project management. 1. Stakeholder engagement Understanding stakeholders is vital to any project. Due to the cross-sector approach within DMS, it was important to identify key stakeholders, and their roles, from across the system (see Box 1). Leadership endorsement We were able to gain endorsement from senior stakeholders through their established Pharmacy Leadership Group (PLG), where members consisted of representatives from each pharmacy sector and across each of the four Places across the Black Country and West Birmingham ICS (a Place is typically defined by its Local Authority boundary, and consists of multiple organisations such as acute Trusts, community providers, GP practices, Community Pharmacies and the Local Authority). The PLG is well established across the Black Country and West Birmingham ICS, and the existing collaboration between the pharmacy leaders from different sectors of the pharmacy workforce was a key enabler to the mobilisation of this project. Our initial discussion with the group enabled the agreement of the overall project objectives: • Increase referrals from baseline rates • Promote the service across the ICS • Achieve sustained referrals This discussion also enabled us to understand the current position and requirements, how project resources needed to be mobilised, and inform the group of the benefits of undertaking an initial onsite scoping exercise. System engagement Arden & GEM established and chaired a bi- weekly DMS task group comprising of system stakeholders representing each of the four Places and across different sectors of pharmacy. The group had a clear governance structure, an established route for escalation (via the PLG), documented roles and responsibilities for each member, and an agreed positive focus on collaboration and sharing good practice. By raising awareness and seeking representation across the system, an increased appetite and commitment from the members became evident: It is expected that this approach will lead to system-wide ownership and a subsequent sustainable service. The following forums were utilised to access stakeholders: a. Engagement events Aimed at those likely to be involved in the DMS process (Hospital and Community Pharmacy teams, CCG/PCN pharmacists and GPs), the focus of these events was to introduce DMS, its benefits and enable delegates to discuss interactive case studies that highlighted the clinical decision- making involved when referring patients. Events allowed an opportunity to learn how patients are supported across the interface. There is an aspiration that this approach will foster cross-sector links and relationships which can benefit future service implementation programmes. b. Support for community pharmacy contractors Community pharmacies and their staff are a fundamental partner for DMS, and we recognised this key stakeholder needed to be involved from an early stage in the project. The LPC have been pivotal in helping the Arden & GEM project team to understand the opportunities and barriers faced within Community Pharmacies and to promote the service to local contractors. We facilitated Trust attendance at local LPC meetings to raise awareness, provide updates on referral activity and help to cultivate positive working relationships across the interface. It was important to review activity data and understand reasons for unprocessed referrals within the Community Pharmacy workflow. This was achieved through local conversations, identifying potential solutions and raising general awareness of any issues being experienced. c. Engaging GP practices For DMS to work effectively and gain maximum benefit, General Practice is a key player to ensuring positive action was taken on any recommendations coming via Community Pharmacy: Feedback loop. To raise awareness and promote use of DMS across General Practice, we established links with the system medicines optimisation committee and Primary Care commissioning teams and produced content for primary care bulletins. Where significant barriers may exist between Community Pharmacy and GP practices, organisations may need to consider providing support to foster relationships and identify local barriers to implementation. Accelerating DMS implementation across an ICS • Supports the Medicines Safety Improvement Programme and avoidable medicines harm at the interface 5 • A study showed that 60% of patients have three or more changes made to their medicines during a hospital stay 6 • Between 50-90% of elderly patients receive a change in medication when in hospital 6,7 • 20% of patients experience adverse events within three weeks of discharge, 60% of which could have been ameliorated or avoided 8,9 • Preliminary published data demonstrated that support from a Community Pharmacy when a patient had been discharged results in lower rates of readmission and shorter hospital stays for those who were readmitted 10 • NICE guidelines make clear recommendations that medicines related communication systems and reconciliation processes should be in place within a week of discharge 11 • The Royal Pharmaceutical Society makes recommendations around communication during a patient’s transfer of care, including accurate, timely, clear and legible record keeping, preferably by electronic means 12 Box 1 – Potential System Stakeholders Senior Stakeholders • Chief Pharmacists • Clinical Commissioning Group (CCG) Head of Medicines Management • Local Pharmaceutical Committee (LPC) Chairs Acute Trust Stakeholders • Principal Pharmacists • Clinical Service Leads • Clinical Teams • Implementation Leads • IT Support • Data Analysts Other • Community Pharmacists • GPs • Primary Care Network (PCN) Pharmacy Teams • Patient representative groups