High Cost Medication Information Poster
Hilary Oldham, Joan Karasu, Emma Lowe, Sharon Platt
Clinical service technicians, Pharmacy Department, Christie NHS Foundation Trust
Introduction
Due to the specialist nature of the Trust the usage of high cost
medication is a routine and regular occurrence. The main aim of
this service evaluation is to increase ward staff knowledge and
awareness of high value medication used within the Trust. This
will hopefully impact on the wastage and cost savings as staff may
be more vigilant when prescribing, reviewing, storing,
reconstituting and administering such medication.
Method
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•
•
•
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A short questionnaire was distributed to a complete nursing
shift on each of our main in-patient wards (a total of 18
nurses), in order to gain an insight as to whether the ward
staff would find such information regarding high cost
medication helpful.
The clinical technicians analysed, discussed and identified
the most commonly used high cost medicines on the wards
within our Trust.
A laminated A4 information poster of commonly prescribed
high cost medication in the Trust was produced, following
infection control protocol and using current and accurate
information from the BNF.
This poster was displayed in the treatment areas on the
main in-patient wards.
A second short questionnaire was then distributed to a
complete nursing shift on each of our main in-patient wards
(a total of 18 nurses), to see if the nursing staff had found
the poster useful.
Results/Discussion
Initial Feedback
16
14
Yes
No
Not Sure
12
10
found the poster informative; 88% said they were unaware of
the actual cost; 50% said that knowing this information would
have an impact on their current practice.
Feedback after the poster
Has it had an
impact on your
practice?
Where you aware
of the cost?
Did you find the
poster
informative?
Yes
No
Not Sure
0%
20%
40%
60%
80%
100%
Comments from the nursing staff on the wards included; “this
would prompt me to ask the prescriber to review a high cost
medication”, “I will be more vigilant to get the stock back from
other wards when they borrow it”, “I was shocked by how much
some of these medications actually cost”, “I think this would be
more appropriate in the prescribers office”.
The poster allows the nursing staff to be more proactive
regarding course length, review dates set and changes from IV
to oral medication as soon as appropriate. It also allows the
staff to determine the most economical combinations of
strengths to provide the dose required. For example,
rasburicase; for a dose of 12mg, using a 7.5mg vial and three
1.5mg vials is significantly cheaper than using two 7.5mg vials
over a course of 5 days.
8
6
Conclusion
4
Staff found that the poster was informative but didn’t realise
quite how much the high cost items were and the cost
implications of failing to review such medications in a timely
manner. Although one dose extra in itself would not seem
excessively expensive, mirrored throughout the Trust over a
period of 12 months, this can mount up with the sheer volume
prescribed. Due to the regular use of some of these medicines
there was a degree of complacency without regard for cost.
Feedback from the staff suggested that it would be useful to
have a second poster displayed in the medical prescriber’s
office to aid increase awareness of cost implications. The poster
will require annual review to update.
2
0
Are you aware of
Would it be
which high cost useful to know
medication is
and the cost
used on the
involved?
ward?
Would you treat
the medication
differently if you
knew it was
expensive?
Do you feel
there is much
wastage?
For the initial questionnaire; 44% of nurses questioned said that
they were aware of which high cost medication is used on the
ward; 78% of nurses asked said they would find it useful to know
which drugs are high cost and the cost involved; 11% said they
would not treat the medication differently (few comments about
treating all medication the same); and 28% felt that there was
some wastage of drugs on the ward. Following the display of the
poster on the wards, final questionnaire showed that; 75% said
that they
References
1. Joint Formulary Committee. British National Formulary
(online) London: BMJ Group and Pharmaceutical Press
<http://www.medicinescomplete.com> [Accessed on 7/04/13]
Date of preparation: 23/09/13