Supporting a busy practice to redesign its medication review process improved medicines use while helping to manage the associated workload.

Background

City Walls Medical Centre is a large, busy, GP practice in Chester city centre. The patient population is approximately 17,000, and this generates over 150 medication reviews per week. The practice requested support from MLCSU Medicines Management and Optimisation (MMO) team to manage the workload associated with medication reviews, simultaneously improving medicines optimisation and patient safety issues, whilst trying to reduce avoidable hospital admissions and improve patient experience.

Action

We deployed a pharmacist and pharmacy technician to work to each work one day per week for a period of six months at City Walls Medical Centre. We supported the practice to redesign its medication review process and delivered a minimum of 50 medication reviews per week. These medication reviews were a mix of telephone and ‘level 2’ reviews i.e. patient medication record-based reviews in the absence of the patient.

Impact

During the six month period, we reviewed 3,383 patients and referred 169 patients back to the practice for completion of a long term condition (LTC) review. Our team conducted medication reviews for 3,054 patients. Reviews included updating the medication regime review date as the patient no longer had repeat medication prescribed or a review had been completed by a GP without the new due date being amended.

Definitive timescales for reviews were set and agreed with the lead GP for patients prescribed antidepressants. Clinical EMIS templates were updated to include a prompt for patients requiring a LTC review. This enabled the advanced nurse practitioner to complete a medication review if the patient was only prescribed items linked to the LTC.

EMIS web functionality was being used to move drugs that have not been issued for 12 months or longer into past drugs. Drugs that might be requested on a when-required basis (e.g. salbutamol inhalers, glyceryl trinitrate sprays and adrenaline injection devices) would no longer show on patients’ repeat medication screens. We identified this as a possible safety risk and after discussion at the practice clinical meeting, the EMIS option was switched off.

Patients who were overdue a medication review and requesting repeat medication were sent a letter by the practice asking them to attend for a medication review. As part of this work, we identified that some patients had not attended for a medication review despite being sent several letters. Our team intervention has now led to patients now having their repeat medication changed to acute and the quantities reduced to one month’s supply, to encourage them to arrange a review.

Following on from the successful six month project, City Walls Medical Centre has approached MLCSU to extend the contract to March 2018. The work has been positively received by all clinicians at the practice and time has been released for all staff members who previously were involved in this work.

We have been delighted with the quality and quantity of work the team has managed to complete in such a short space of time. They have not only reduced the burden on the practice access but also have been fundamental in improving the cost and optimising prescribing. Their knowledge and interaction with team members has also been invaluable and I would recommend them as a great resource for any practice.
Kathy Capper-Moore, Nurse Partner, City Walls Medical Centre