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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