Medicines Re-ablement - Patient Safety in Medicines Management
Project Plan 

Introduction
Health and Social Care provision in Sheffield is currently experiencing a significant level of change.  The macro-economic climate, the Health and Social Care Bill (2012), demographic change and increasingly numbers of people with complex co-morbidities are all key factors driving the need to deliver more effective, integrated care solutions in people’s homes wherever possible.

The Sheffield Community Intermediate Care Service (CICS) Transformation Programme had already identified service integration opportunities. In line with these aims there is also broad consensus that some form of integration between Health and Social Care provider services would lead to better outcomes for patients and a more efficient delivery model of medicines re-ablement. The need to provide integrated services has been supported by front line staff and managers for some time.

There is no clear definition of medicines re-ablement but it can include medicines counselling, education, prompts and devices to enable self medication by a person in their own home.

Background - Medicines management in the community in Sheffield
Medicines are the second highest expenditure in the NHS, between a third and a half of medicines that are prescribed are not used as recommended. This is a health loss for patients and an economic loss for society (NICE 2009). Pharmacy interventions were evaluated in 2011 by Sheffield Community Intermediate Care Service (CICS). This showed that medicines optimisation is best achieved when health and social care work together. Currently this is not a standard approach to care.

‘Medicines optimisation is about ensuring that the right patients get the right choice of medicine, at the right time.’  Royal Pharmaceutical Society 2013

A recent local evaluation (Black and Glaves 2011) on medicines optimisation in health identified that pharmaceutical re-ablement was key to promoting patient independence and wellbeing. Pharmacy time promoting this reduced the need and frequency of social care packages for medicines administrationAssessing patients and, where appropriate, setting goals regarding self-administration, allows an assessment to be made of how many social care packages are avoided for patients who achieve their self-administration goal.  

Eighty-two percent of patients involved in the project achieved their goal to be independent with medicines administration, 20 per cent visited to assess ability for self-medication resulted in a social care package not being needed or the frequency of the calls being reduced – a saving of £115,000 for social services in the 3 month project period.

In response to the findings of the above evaluation, a proposal for a pilot project to enable the alignment of health and social care services for training on and the practice of medicines re-ablement was developed and agreed by the Intermediate Care Partnership Management Board with support from CLAHRC SY.

The pilot has currently delivered a robust and standardised medicines management training and application into practice to AFC Band 2 health and equivalent community care staff (approx 80 staff) in the North of the City. The Department of Health NHS Outcomes Framework 2013/14 highlights that there is a need to develop and measure experience of integrated care in response to the views of patients, service users and care organisations who report that too often patients experience gaps in service provision between services.

This ten month (January-October 2013) project is a partnership between Health, Social Care and the Translating Knowledge into Action theme (TK2A) of the Collaboration for Leadership Applied Health Research and Care for South Yorkshire (CLAHRC SY). The pilot is being undertaken within Sheffield City Council Short Term Intervention Team (STIT) and the NHS Community Intermediate Care Service (CICS) to develop a robust, standardised medicines management training and practice across the pilot area. CLAHRC SY is contributing towards identifying the evidence base, supporting the training package and the evaluation of the project.

Project Aims

  • To pilot the implementation of a competency training package to provide high quality, safe, standardised medicines re-enablement care service within intermediate care services
  • To evaluate the impact of the medicines re-enablement training package from the perspective of patients and staff 
  • To make recommendations for scaling-up the medicines re-enablement service across intermediate care services across Sheffield 

Objectives

  • To undertake a scoping review of the literature and provide a report on the available evidence to inform medicines re-enablement
  • To evaluate the pilot medicines re-enablement competency training package from the perspectives of the training facilitators, care providers and managers
  • To evaluate the success of the medicine re-enablement service from the perspective of care providers, managers, patients / family carers
  • To collate data on the numbers of patients engaging in re-enablement, numbers of patients successfully re-enabled, time saved on visits for health and social care staff

Project Approach
A service improvement approach employing stakeholder involvement including staff, patients and, if appropriate, carers will be applied to assess the implementation of the medicines re-enablement training competency package and integrated service.  The Knowledge to Action Cycle (Graham et al 2006) provides the conceptual underpinning.  

A scoping review of the literature on medicines re-ablement has been completed. 
Specific staff, patient and where appropriate carer perspectives are being gathered using interviews. Staff are evaluating their training needs in relation to re-ablement and providing feedback on the training programme using questionnaires. A basic cost analysis reflecting the work of Black and Glaves (2011) will be undertaken.