P004 A quality improvement project at Bradford Teaching Foundations Hospital to reduce high-cost medication waste and improve medicines optimisation
Authors: Sidhu Prabhdeep , Quinn Gemma , Nadesalingam Kavitha 
Published: April 2022

Abstract

Background/Aims
Biologics and methotrexate are high-cost medications delivered to patients through pharmacy homecare services prescribed and dispensed at 8-weekly intervals in our Trust. It is estimated nationally, £300 million of NHS prescribed medicines are wasted annually. The aim of this quality improvement project (QiP) was to investigate the extent and reasons for high-cost medication waste within the rheumatology department at BTHFT and develop a service to overcome these issues thereby improving medicine optimisation and reducing waste.

Methods
Homecare data was reviewed over 12 months from Jan 2020- 21 looking at high-cost medication waste within rheumatology at BTHFT. Two hundred and sixty-seven rheumatology patients were initiated on therapy in this period. Forty-four (16%) patients stopped therapy within a year of initiation. Of the 44 patients, 32 patients stopped within their first 8-week delivery resulting in £17,362 in wastage of medications. On further analysis, reasons for treatment cessation included: adverse effects, non-adherence due to lack of response or patient choice, lack of information and change in treatment plan by overseeing consultant. To overcome some of these issues we changed initial prescribing methods and dispensed 4 weeks supply of medication. We set up a pilot pharmacy telephone clinic between 9th April and 18th June 2021. Patients were phoned 8 weeks after nurse counselling when patients should have been 3 weeks into treatment with their new biologic and provided with further information and reassurance. Any clinical queries outside the pharmacist’s remit were directed to the rheumatology team. If patients were continuing medications, a further appropriate length prescription was dispensed.

Results
Over the 10-week period of the pilot study, 83 new patients started on therapy, 46 of these were provided with reassurance/support and of those, 9 held/stopped treatment. Through the pharmacy support line, £2,612 of medication cost was saved as these patients had received 4 weeks of medication rather than the usual 8 weeks supply. This translates to approximately a potential of £13,500 of medication waste which can be saved annually through reduced initial prescription of biologics together with implementation of a pharmacy support line through the rheumatology department alone. Another unexpected benefit of the pharmacy support line was improved compliance and adherence to treatment through further counselling and guidance that was delivered to patients who may have stopped treatment without the additional support provided by the pharmacist.

Conclusion
The introduction of a pharmacy-led telephone support service together with a change in prescribing practice can reduce waste, save money and improve patient outcomes through medicine optimisation. This service could be rolled out to other specialties using high-cost medication with similar intended benefits. Enhancing roles of pharmacists in this way will help meet increasing demand and improve services for patient as recommended by the recent rheumatology GIRFT review.

Disclosure
P. Sidhu: None. G. Quinn: None. K. Nadesalingam: None.