Electronic Repeat Dispensing

Electronic Repeat Dispensing (eRD) enables GPs to authorise up to a year’s worth of repeat medication for patients whose repeat medicines are relatively stable. Community pharmacists can then carry out a number of checks and dispense the medicines at regular intervals, usually monthly.

While eRD is not new, uptake is hugely variable with many practices having never taken advantage of this technology.

During the COVID-19 pandemic, primary care systems were encouraged to increase rates of eRD to reduce the number of patients visiting GPs for repeat prescriptions. To support our colleagues, the West of England AHSN worked in partnership with South West AHSN to deliver a series of five webinars and shared a wide range of resources.

Transfer of Care Around Medicines

Since 2018 we have been supporting the AHSN Network’s national Transfer of Care Around Medicines (TCAM) programme. All hospital trusts in the West of England have implemented a TCAM communication system.

When some patients leave hospital they may need extra support taking their medications, especially if changes have been made to their prescription.

The aim of TCAM is to ensure that when a patient leaves hospital, they have access to support so they understand the medicines they have been prescribed. It identifies patients upon discharge who may be at risk from adverse effects or need help with their medicines, and refers them to their usual community pharmacy for advice and support.

During the Covid-19 pandemic, we spotted an opportunity to reorient TCAM to focus on patients being discharged to care homes and new residents moving into care homes.

Led by our Medicines Safety Steering Group, comprising specialist clinicians from across the West of England, we pivoted our work to supporting reviews of new care home residents or those recently discharged from hospital by sending messages directly to community based pharmacy teams that support care homes with their medicines management.

Medicines Safety Improvement Programme

One of five National Patient Safety Improvement Programmes, we are supporting the Medicines Safety Improvement Programme, which aims to reduce medication related harm in health and social care, focusing on high risk drugs, situations and vulnerable patients.

The programme will contribute to the World Health Organisation’s ‘Medication Without Harm’ challenge target for 2023 to reduce severe avoidable medication related harm globally by 50% over five years.

In the last year, we have contributed to the development of the programme’s two main workstreams: reducing medicine administration errors in care homes; and reducing inappropriate high-dose opiate prescriptions for non-cancer pain.

Reducing medicine administration errors in care homes

The aim of this programme is to reduce medicine administration errors in care homes by 50% by 2024.

We supported the national team by sharing their survey with care homes in the West of England to better understand the perspectives and experiences of care home managers and staff about the risks and issues with medicine administration. The intelligence gathered has identified key priorities for the programme in the coming years:

• Use of safety huddles
• Learning from errors
• Managing interruptions
• Three-way communications (care home, GP, community pharmacy).

We will also support care homes better to understand their safety culture and develop safety champions.

Reducing inappropriate high-dose opiate prescriptions for non-cancer pain

The aim of this programme is to reduce harm from opioid medicines by reducing high dose prescribing for non-cancer pain by 50% by 2024.

We have been working with all regional stakeholders to gain a better understanding of the high-dose opioid issues at a local level.

We helped to scope current provision for alternatives, exploring effective interventions that reduce opioid prescribing for chronic non-cancer pain. We identified five impactful approaches that have been tried, tested and evaluated in the West of England, which we submitted to a national repository for review. These will inform the next phase of this programme in 2021/22.

Medicines Compliance Aids

In the last year we carried out scoping work for our new project to optimise the dispensing of Medicines Compliance Aids (MCAs).

MCAs are not always used appropriately and evidence shows they can actually increase risks to patients.

We distributed baseline surveys to community pharmacies to ascertain the number of the MCAs currently being dispensed and to test a potential standardised method to assess for ‘reasonable adjustments’. Our aim is to reduce use of MCAs by 20% over the next year.