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
Zero tolerance policy
to medicines waste
Hospital
now in place in a
Waste Audits
number of Trusts
Regional
Collaboration
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
Zero tolerance policy
to medicines waste
Hospital
now in place in a
Waste Audits
number of Trusts
Second annual
utilisation and
£ savings audit
complete
POD
Green Bags
Regional
Collaboration
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
Zero tolerance policy
to medicines waste
Hospital
now in place in a
Waste Audits
number of Trusts
Second annual
utilisation and
£ savings audit
complete
POD
Green Bags
Incorporating
secondary care
for the first time
Regional
Collaboration
Regional
awareness
campaign
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 2010
Comparison 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
Zero tolerance policy
to medicines waste
Hospital
now in place in a
Waste Audits
number of Trusts
Second annual
utilisation and
£ savings audit
complete
POD
Green Bags
Incorporating
secondary care
for the first time
Inhaler
Technique
Regional
Collaboration
Regional
awareness
campaign
Showing demonstrable
reductions in
emergency admissions
Meds Rec
database
Four
innovation
pilot projects
From a regional
initiative to a
national database
The first pilot project
delivering £10K per
annum with potential
for £1.6m region-wide!
The NHS South Central Project: 2010 - 2012
Zero tolerance policy
to medicines waste
Hospital
now in place in a
Waste Audits
number of Trusts
Second annual
utilisation and
£ savings audit
complete
POD
Green Bags
Incorporating
secondary care
for the first time
Inhaler
Technique
Regional
Collaboration
Regional
awareness
campaign
Showing demonstrable
reductions in
emergency admissions
Meds Rec
database
Four
innovation
pilot projects
From a regional
initiative to a
national database
The first pilot project
delivering £10K per
annum with potential
for £1.6m region-wide!
Improving Quality, Safety and Cost
Project
Avoided Costs /
Real Cost Savings
2011/12
Delivered
2012/13
Forecast
2013/14
Forecast
Patient's Own Drugs
Green Bags
Real cost savings
40%
50%
75%
Medicines
Reconciliation
Avoided costs
500,000
admissions
£2.5million
800,000
admissions
£4million
1000 reviews
1,100,000
admissions
£5.5million
Inhaler Technique
Avoided costs
5000 reviews
(but now a national
scheme)
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
Zero tolerance to waste
in secondary care
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
Report levels of
waste to Trust
Boards
Waste Audits
Process
review to
maximise POD Green
Bags
POD
Utilisation
Develop a
campaign to
empower the
patient: ‘collect
what you need’
Inhaler
Technique
Regional
Collaboration
Regional
awareness
campaign
Care Homes
and carers
Meds Rec
database
Four
innovation
pilot projects
Engage and
evaluate
scale of waste
MDS boxes
Patient
pathways &
adherence
Assess opportunities for wider role out and
implement a second round of pilot projects
Learn
from
pilot and
scope
Map links
between
systems and
improve patient
supports