I was delighted to hear that Faisal Bokhari, Deputy Head of Medicines Optimisation and Non-Medical Prescribing Lead, had made authentic patient and public involvement in medicines the subject of the inaugural event for the Non-Medical Prescribers Continuing Professional Development programme for Tameside and Glossop.
The session introduced the CPD programme and set the scene for the coming months and then Graham Prestwich shared the Me and My Medicines story, showing how a simple approach could help to overcome some of the barriers to the more effective and safer use of medicines, particularly for those people with long term conditions.
The George Hatton room in Dukinfield town hall was packed and at 50p to park for four hours a bargain!
Using real time on-line voting it showed that the event comprised mainly nurses working in primary care settings, a perfect audience for the subject.
In the introduction Faisal Bokhari welcomed all the Non-Medical Prescribers to their CPD session and set the scene by giving an introduction to the Non-Medical Prescribing agenda across Tameside and Glossop. The Non-Medical Prescribers were informed about the ongoing developments around Non-Medical Prescribing especially up-coming potential regulatory body changes. Non-Medical Prescribers will have the option of 1-2-1 or group support with Faisal Bokhari on topics of their choice and a key message was the CPD sessions are for Non-Medical Prescribers to own so they need get involved in choosing the sessional topics.
Non-Medical Prescribers were asked to have discussion on their tables on reflecting on how they identify CPD and what methods do they utilise to undertake CPD. The aim of this discussion was to break the ice between Non-Medical Prescribers working across the interface of primary and secondary care but more importantly to emphasise the importance that CPD starts with reflection to ensure real added benefit.
The new integrated Non-Medical Prescribing Policy was introduced highlighting requirements for Non-Medical Prescribers and how the policy was a support document for the prescribers. The CPD sessions, to be held every two months, will be a platform to integrate and support each other irrespective of the organisation they work for. The vision for the CPD sessions is to undertake learning as a collective to ensure that Non-Medical Prescribers can support each other to be able to provide similar level of care to our patients in Tameside and Glossop without compromising patient safety and integrate into Multidisciplinary Teams (MDTs) in primary and secondary care. Another added benefit of these sessions is for newly qualified prescribers to integrate with experienced prescribers to discuss day to day challenges regarding consultation skills, shared decision making, legal and ethical considerations, reaching a prescribing decision and other issues.
Me and My Medicines was a great session to allow our Non-Medical Prescribers to start reflecting about their own practice and think about how to incorporate the principles of the charter in their practice. Ongoing CPD sessions will be on individual topics that form Non-Medical Prescribing but more importantly what our Non-Medical Prescribers want to learn at their CPD sessions.
An ageing, increasingly co-morbid population is putting greater demand on primary care. At the same time primary care is seen as the most cost –effective means of delivering care to this population and the place of choice where most should be treated, clinical condition allowing. Between 5 and 8% of all unplanned hospital admissions are due to issues related to medicines (this figure rises to 17% in the over 65s).
Some common issues that are identified regarding patients taking medication are:
- Up to 50% of medicines are not taken as intended by the prescriber
- Multi-morbidity and inappropriate polypharmacy particularly in frail elderly people can be problematic. These patients need regular review of their medicines to ensure that all medicines prescribed, or bought over the counter, are safe and appropriate.
- There is often a communication breakdown at the point of discharge from hospital resulting in prescribing errors. These errors can lead to damage to health, much time wasted for administrative and clinical teams in primary care and potential re-admission to hospital.
From the patient point of view, with increased focus on person-centred care, there is much more to be done to allay concerns about polypharmacy and address limited support with medicines taking. Me and My Medicines and the Charter is one useful tool to assist patients to get the best possible outcome from their medication.
The learning outcome for the session was to consider the current approach to supporting people with their medicines, take a fresh look at the experiences of patients and carers and by adopting the Medicines Communication Charter explore with patients and carers how to improve health and wellbeing through behaviours that support the more appropriate use of medicines.
Every three months around one million items are prescribed in Tameside and Glossop, the challenge remains that prescription medicines are not used as effectively, safely or as appropriately as they could be for a wide variety of reasons. Patients, and very often their carer or family, have an important role and responsibility in helping to ensure that the medicines are understood, taken as directed and the appropriate follow on actions are taken to ensure a regular supply. As the number of medicines increases, the challenges become greater and the chances of unwanted and unexpected side effects increase. This gives rise to issues and problems and some people may simply choose to stop taking something that makes them feel unwell. The sub-optimal use of medicines is a problem that has been known for many years and is unfortunately still common despite a variety of attempted solutions.
The story of Me and My Medicines, a novel patient led and patient developed approach to a solution, was discussed. The key points highlighted which patients had raised in focus groups and discussions were:
- Patients need some help so that they can contribute effectively to improving their use of medicines.
- For each professional contact the quality and nature of the conversation is critically important, making the communication behaviours of patients and professionals critically influential in achieving a good outcome
- Most patients are prepared to take on some responsibility with the right help and support
The essence of Me and My Medicines is the Medicines Communication Charter, making a straight forward agreement between patients, carers and professionals to reach a shared agreement. Further details here
The comparison was made between patients and their medicines responsibilities and project management, making sure routine tasks are done on time and done properly. Based on this comparison the audience was asked to consider the behaviours of good project managers, and there were some 180 responses from the audience which for the ease of presentation were presented as a word cloud, the top five words were motivated, ask, understand, good, and listen. Motivated stood out, having someone who is keen and interested in achieving good outcomes from their medicines with fewest unwanted effects is crucially important.
The follow on question for everyone to discuss, and judging by the buzz in the room there was a lot of healthy debate, was what support would make them a better project manager? The headline words that came up were good patient support. This suggests that there is scope to improve a more personalised approach to the support someone has so they can overcome their unresolved issues relating to their medicines, whatever those unresolved issues may be.
The final question for everyone to consider was what can the health professional do to help patients better manage their medicines project and the headlines were listen, be patient, ask and understand. Listen was by far the most prominent response, suggesting that the audience felt there was a clear and specific behaviour that can easily be enhanced to help people and that is to simply listen to them and seek to understand how to help.
By the close here was growing interest and enthusiasm in the room for helping people to get the best possible outcomes form their medicines and it is hoped that the Medicines Communication Charter and the associated website and Twitter @MeAndMyMeds will be contributing to local strategies. There was lots of positive feedback from the Non-Medical Prescribers and a common theme emerging was to support and involve the patients to take decisions about their own care.
The next step is to try the approach for yourself, using the charter which can be downloaded from the website and to encourage further work through your Medicines Optimisation lead and Health Innovation Manchester. Alternatively, you can contact the Me and My Medicines Team directly via the website.
Faisal Bokhari – Deputy Head of Medicines Optimisation and Non-Medical Prescribing Lead, Tameside and Glossop CCG
Graham Prestwich – Patient and Public Involvement Lead, Yorkshire & Humber Academic Health Science Network