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The benefits of this project
Benefits for Your Patients
- Holistic care with individualised medication reviews
- Fewer medication side effects
Benefits for Your Practice
- Financial savings and reduced prescription administration
- £13,100 direct cost savings and £168,800 indirect savings per 100 SMRs
Benefits for The Planet
- Reduced prescribing means lower environmental impact
Opportunity for improvement
- Medicines account for 25% of all NHS carbon emissions in England and £300 million is wasted because of medicines which are stockpiled or thrown away. Up to 50% of medications are not taken as intended which has an impact on patient care as well as the environment.
- This quality improvement project aims to identify patients who are non-adherent to their medication by opportunistically asking the screening question “Show me your meds, please” during home visits (see disclaimers). Patients who aren’t taking their medications as prescribed may have large amounts of medications stored at home.
- A pilot study has demonstrated positive outcomes in detecting non-adherence and targeting patient-centred interventions, leading to simplification of medication regimes, referral to appropriate social support and large cost and environmental savings.
- The screening question allows the practice team to target existing structured medication review (SMR) efforts. Prioritising patients who are non-adherent to medications is likely to result in high impact SMRs, huge waste and cost savings and offers an opportunity to provide holistic support to the patient via use of the multi-disciplinary team.
- You might find these resources helpful for reducing medicines waste.
How to carry out this project
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Gather a team
This can include anyone at the practice or within locality who visits patients at home – e.g. pharmacy technician, GP trainees, paramedics, advanced nurse practitioners.
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Create a pathway
Establish a pathway for patients identified during the visit as non-adherent – this could be to refer for a medication review with pharmacist or GP, or to discuss complex patients as an MDT (may include GP with interest in frailty, home visiting team, pharmacy lead at the practice).
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Ask the question
For every visit during the project duration – ask the patient to show the health professional all medications they have in the house – “Show me your meds, please”.
The initial question can be asked by anyone visiting a patient at home. No specific training is needed – they can then refer patients via the pathway when needed.
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Identify patients who need help
Asking the screening question will help pick up patients who may not to be taking their medications as prescribed – e.g. stockpiled meds, unused or out of date medication, or patient uncertainty over how they are taken. Let the project lead know the outcome.
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Medicines disposal
Encourage them to return unwanted or out of date medication to pharmacy for disposal.
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Next steps
Project lead & MDT discuss who is best to work alongside the patient and next steps. These could be:
- Clinician e.g. pharmacist or GP to perform home visit for medication review
- GP phone call or appointment
- Cognitive assessment
- Social Prescribing referral for carer or social support
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Data collection
Document the total number of patients asked the screening question, how many are identified as non-adherent and the final outcome – e.g. how many medications stopped or simplified, referrals for social prescribing or cognitive assessment.
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Study
Review the results, summarise learning, share with practice team + decide if any changes are needed to improve the process. Use the Project Monitoring form to keep track of the project and how often to review the data.
How to scale this project up or down
| Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members. |
Consider liaising with other local practices e.g. your PCN or Cluster – is there a visiting team or Complex Care Team who would consider incorporating this question into their existing visits?
Case study
The initial Show me your meds please pilot ran over a 3-month period. It identified 40 patients not adhering to their medication as prescribed.
1049 individual months of unused prescription items were identified.
Wasted medication was valued at £10866.
It is estimated that every pound spent on pharmaceuticals generates greenhouse gas emissions of 0.1558kg CO2 per pound (£), representing avoidable CO2 emissions of 1693 Kg.
39 medications were stopped providing predicted cost saving over the next 12 months of £3529 and 549 Kg CO2 emissions prevented.
Medication regimes were simplified in more than 50% of cases.
Social prescribing was initiated in 30% of cases.
New cognitive impairment was identified in 35% of cases.
South Somerset
Have you completed this QIP?
Tell us a little about your project in order to generate a certificate showing the probable benefits. This project may help with CQC evidence submission (see disclaimers).
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