The Cheshire and Merseyside initiative, aimed at aligning medication guidelines, has enhanced medication management practices across the region. By improving consistency, streamlining processes, increasing transparency, and promoting continual improvement, the project ensures safer and more effective medication usage, thereby contributing to the overall quality of healthcare delivery in Cheshire and Merseyside. 

Background 

With the establishment of the NHS Cheshire and Merseyside Integrated Care Board (ICB), there arose a need to unify the existing Cheshire and Merseyside formularies. 

A ‘formulary’ in the context of medicines management is essentially a list of approved medicines for use within a healthcare organisation, like a hospital. Its primary function is to specify which medicines are sanctioned for use under specific circumstances. 

NHS Midlands and Lancashire Medicines Management Optimisation team, based in Liverpool, serves as the administrative support team for the newly formed Cheshire and Merseyside area prescribing group (CMAPG) and its five subgroups. The NHS Cheshire and Merseyside ICB acknowledged the expertise of the Medicines Management Team and entrusted them to lead the harmonisation project, with five pharmacists involved in the process. 

Formulary harmonisation refers to the process of aligning and integrating medication guidelines from different healthcare organisations or regions. In the case of Cheshire and Merseyside, this initiative aims to unify the medication formularies of these areas, ensuring that healthcare providers have consistent and standardised guidelines for medication use. By harmonising the formularies, the project aims to improve patient safety, enhance the quality of care, and streamline medication management processes across the region. 

Action 

A set of rules was devised, drawing from common scenarios identified through a review of sections from both legacy formularies. These rules aim to ensure consistency in the review of chapters. In cases where an appropriate action is unclear, matters are escalated to a harmonisation working group. 

A paper outlining the general process and rules and defining when actions would be referred to the working group for review and how the information would be incorporated into the harmonised formulary was approved at CMAPG in August 2023. It was then presented to the ICB clinical effectiveness group for consideration and approval, ensuring support and endorsement from the ICB. 

The paper outlined the following steps: 

• Establish the governance, membership, and purpose of the working group 

• Develop draft formulary chapters as reviews are completed 

• Present finalised chapters to the CMAPG with a summary of the rationale 

• Publish the completed formulary 

Impact 

The membership of the working group has been established to include pharmacists from primary and secondary care in both Cheshire and Merseyside. The governance and purpose of the group, which convenes monthly, have been agreed upon. 

Spreadsheets have been created for each chapter, containing the positions from both the legacy Cheshire and Merseyside formularies, along with individual columns for each matching rule. 

Drugs that cannot be matched using the harmonisation rules are compiled into reports for discussion by the harmonisation working group and decisions made during these meetings are documented. 

In cases where a decision cannot be reached by the working group, both legacy positions are retained in the new harmonised formulary until a full formal chapter review is conducted by the Formulary and Guidelines subgroup. These reviews are conducted promptly after a chapter is harmonised. As the project progresses, the team continues to identify more harmonisation rules, updating the working document accordingly. 

The Cheshire and Merseyside formulary harmonisation project has improved medication management across the region by improving consistency, streamlining processes, increasing transparency, and promoting continual improvement. These outcomes not only ensure safer and more effective medication usage but also contribute to the overall quality of healthcare delivery in Cheshire and Merseyside. 

Feedback 

Colleagues working on the harmonisation of two historic formularies within Cheshire and Merseyside have undertaken significant work in terms of planning, system consideration, engagement, and delivery of work to date. The team have been flexible in their approach, welcomed feedback with a focus and commitment to get the job done and to deliver the best outcomes for patients, clinicians and the system. The task has not been simple but the commitment, teamwork and leadership within the team has been excellent.

Susanne Lynch | Chief Pharmacist | NHS Cheshire and Merseyside 

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