Meet the team
Vivian De Vittoris
Lead Pharmacist - Quality Improvement and Medicine Optimisation
Nottingham University Hospital NHS Trust
- England - East Midlands
- Alexander Spurling, Specialist Pharmacist - Acute Frailty
- Claire Patel, Lead Pharmacist for Medicine
- Jo Darrow, General Manager Integrated Care
What is the challenge your project is going to address and how does it connect to your chosen theme?
A third of people over 65 fall at least once a year with associated consequences including injury, increased morbidity and mortality. Cost burden to the health economy is estimated at £2.3 billion and 4 million bed days. At NUH the HCE Department own the outpatient activity. The clinic focuses heavily on bone health with a lack of focus on medication reviews.
Two referral mechanisms include:
1. Hospital clinicians. Frailty pharmacists also generate referrals which has driven increased outpatient activity
2. Community therapists who direct medicine issues to GPs, compounding capacity challenges within this setting
Challenges to be addressed:
– Absorb a proportion of activity being driven through the current outpatient model by managing patients closer to home.
– Improve capacity in general practice
– Increase the proportion of high risk patients receiving a medicine review across the interface
– Reduce demand on A&E by reducing falls /fracture admissions for patients on high risk medicines
What does your project aim to achieve?
The project aims to create a referral pathway that supports patients who have fallen or at risk of falling, with the intention of providing comprehensive medicine reviews by an advanced clinical pharmacist. This supports a key component of multifactorial falls risk assessment within NICE and supports the NHS Rightcare pathway for frailty related to falls and fragility fractures.
1. Redesign the referral pathway with key stakeholders
2. Analyse the following:
– Referrals appropriately managed and the associated reduction in activity through NUH’s Fall and Bone Health Clinic
– Number of GP appointments avoided
– Physical drug costs saved through appropriate deprescribing
– Risk reduction to patients, with a focus on high risk drugs e.g. drugs of dependence.
– Admissions through NUH ED and associated bed days saved.
3. Explore a mechanism to proactively identify high risk patients, supporting a preventative intervention, negating future referrals.
3. Patient experience
How will the project be delivered?
We will require a specialist non-medical prescriber with a special interest in falls and medicines to undertake the medicine optimisation reviews. Training can be provided in house.
Early engagement has been positive with wide support from multiple stakeholders. On successful shortlisting, further engagement from the following stakeholders will ensure appropriate pathway redesign:
– Senior clinicians within HCE
– Divisional Lead for Integration (Project Exec Sponsor),
– Local CCGs using existing strong relationships
– NUH’s Improvement and Transformation Team
The project will be designed and evaluated using a number of QSIR techniques and methodologies which will be absorbed and driven by the project team. Project governance is to be supported through NUH’s Harm free Care Improvement Group and the Medicine Governance Committee.
Measurement for improvement will be led by the Lead QI Pharmacist with support from divisional analysts and NUH’s Data & Insight Team.
What and how is your project going to share learning throughout?
Analysis and Evaluation of the new service pathway will be conducted and the findings shared with the following organisations:
– Locally at NUH: Harm Free Care Improvement Group and Medicines Governance Committee
– Regionally: Amongst CCGs and across the ICS at the Nottinghamshire ICS Medicine Optimisation Committee
– Nationally: Using existing links with clinical fellows at NHS Improvement. Provided improvement metrics are robust enough there is an opportunity to support national recommendations. Similarly support can be seeked within the Medicine Optimisation team at the East Midlands AHSN
How you can contribute
|1 Aug 2019||Explore detailed pathway redesign with key stakeholders|
|1 Aug 2019||Extract baseline data|
|1 Aug 2019||Scope training requirements|
|1 Sep 2019||Present project plan and design to governance committes|