Can we afford to waste medicines?- update on possible national strategies

Bhulesh Vadher

Clinical Director of Pharmacy and Medicines Management , Oxford University Hospitals

South Central Experience

Many thanks for Leadership and support from:

Clare Howard

QIPP Medicines use and Procurement Lead

Linda Trait

Programme Manager Medicines use and Procurement

Liz Bere

NHS Southampton Clinical Commissioning Group

South Central Chief Pharmacists and Medicines Management Leads

Old South Central Geography

Recognising a National Issue

From defining in 2010 …… To planning in 2012

The NHS South Central Project: 2010 - 2012

Regional Collaboration

Hospital Waste Audits

Zero tolerance policy to medicines waste now in place in a number of Trusts

Medicines Waste Self Assessment • Policy - Return Drug Policy to manage risk and return all reusable

medicines

• Resources - Cost effective staffing mode

• Process - Ensure a Zero tolerance approach is taken.

• Process - Ensure part pack reuse systems are in place

• Training - In place for returning all appropriate medicines

• Monitoring - Monitor month on month financials

• Audit - Annual sample of a 1 week to 1 months returns

• Senior staff - Visual inspection to identify potential benefits

Collaborative working:

Key: Shared self assessments

Heat Map•Waste Audit (1 week)•Total Returns ( Annually 2009 to date)•Returning all available medicines (Self Assessment)•Outcomes Achieved

– 100% savings returned to pharmacy budget– Year on year reduction in waste– Raised Board awareness

An Action Plan

• Trust Board level reporting of medicines waste

• Invest to save: install resource to facilitate waste

• reduction and recycling• Conduct annual waste

audits

The NHS South Central Project: 2010 - 2012

POD Green Bags

Regional Collaboration

Hospital Waste Audits

Second annual utilisation and £ savings audit complete

Zero tolerance policy to medicines waste now in place in a number of Trusts

An Action Plan

• Conduct annual POD volume• Plan to increase volume and

improve management of patient’s own drugs

• Remove barriers to patient’s routine arrival with PODs

• Review discharge process • Support patients beyond

discharge

Use of Green Bags and POD’s

The NHS South Central Project: 2010 - 2012

POD Green Bags

Regional Collaboration

Regional awareness campaign

Hospital Waste Audits

Incorporating secondary care for the first time

Second annual utilisation and £ savings audit complete

Zero tolerance policy to medicines waste now in place in a number of Trusts

Awareness campaign

• Population of 4 million• 694 Community Pharmacy's• 494 GP surgeries• 11 hospital trusts• 4000 pre and post evaluation patient

questionnaires• 510 patient surveys• 260 professional surveys.

Key Message using Dynamic Advertising Group

• Think before you order– Only order what you need

• Unused Medicines can not be recycled– Wasted Medicines cost NHS South Central £20million

per year

• Look after your medicines– Picture of standard pharmacy Green bag– The Green Medicines bag helps keep your medicines

with you when you move wards and go home from or come into hospital.

Observations of the campaign are:

A social marketing campaign is hard work:-

•diligent planning•resource intensive•early engagement of health professionals (clinicians vs patients)

A medicines waste social marketing campaign is about long term cultural change

The main findings of the evaluation are as follows:

• Need to sustained over a longer period • Regular and repeated evaluation• Materials and messages should be reinvented• Market segmentation• Multi-faceted or multi-modal.• Effective utilisation of media channels• Alignment to practical interventions • Targeting by disease type• Good recall but no significant variations in behaviour

Synthesis of Food Waste Compositional Data 2010Comparison of national food waste arising estimates for England (kg per household per year) Ref: WRAP( Waste Resource Action Program)

UK Supermarket Retailers Voluntary Carrier Bag Agreement 2011 Carrier Bag Use WRAP July 2012

UK Supermarket Retailers Voluntary Carrier Bag Agreement 2011 Carrier Bag Use WRAP July 2012

The NHS South Central Project: 2010 - 2012

POD Green Bags

Meds Rec database

Four innovation

pilot projects

Regional Collaboration

Regional awareness campaign

Hospital Waste Audits

Inhaler Technique

From a regional initiative to a national database

Showing demonstrable reductions in emergency admissions

The first pilot project delivering £10K per annum with potential for £1.6m region-wide!

Incorporating secondary care for the first time

Second annual utilisation and £ savings audit complete

Zero tolerance policy to medicines waste now in place in a number of Trusts

The NHS South Central Project: 2010 - 2012

POD Green Bags

Meds Rec database

Four innovation

pilot projects

Regional Collaboration

Regional awareness campaign

Hospital Waste Audits

Inhaler Technique

From a regional initiative to a national database

Showing demonstrable reductions in emergency admissions

The first pilot project delivering £10K per annum with potential for £1.6m region-wide!

Incorporating secondary care for the first time

Second annual utilisation and £ savings audit complete

Zero tolerance policy to medicines waste now in place in a number of Trusts

Improving Quality, Safety and CostProject

Avoided Costs /Real Cost Savings

2011/12Delivered

2012/13Forecast

2013/14Forecast

Patient's Own Drugs Green Bags

Real cost savings 40% 50% 75%

Medicines Reconciliation

Avoided costs500,000

admissions £2.5million

800,000 admissions £4million

1,100,000 admissions £5.5million

Inhaler Technique Avoided costs 5000 reviews1000 reviews

(but now a national scheme)

 

Zero tolerance to waste in secondary care

Real cost savings £200K £500K £800K

Social marketing campaign

Enabler(raising awareness)

n/a n/a n/a

Four innovation competitions

Real cost savings £10K

The team won an NHS Innovation Challenge for its collaborative approach to tackling medicines waste.

Our three challenges now …

•To prove the value of the collaborative concept

•To go further, faster and make a real difference to patient care

•For the project to sustain itself in the new NHS structures

The NHS South (TV and Wessex) Project 2013

POD Green Bags

Meds Rec database

Four innovation

pilot projects

Regional Collaboration

Regional awareness campaign

Waste Audits Inhaler Technique

Learn from pilot and scope

Assess opportunities for wider role out and implement a second round of pilot projects

Develop a campaign to empower the patient: ‘collect what you need’

Process review to maximise PODUtilisation

Report levels of waste to Trust Boards

MDS boxes

Care Homes and carers

Engage and evaluate scale of waste

Patient pathways & adherence

Map links between systems and improve patient supports