NHS Ayrshire & Arran

Acute Care Specialty Effective Prescribing Reviews

NHS Ayrshire & Arran has established an Acute Care Effective Prescribing Group (ACEPG). The group has been tasked with reviewing quality and effectiveness of all areas of prescribing within Acute Care in NHS Ayrshire & Arran.

To support this work the ACEPG has carried out a number of Acute Care Specialty Effective Prescribing Reviews inviting specialty Clinical Directors to meet with the ACEPG to discuss the use of medicines within their area.

A proforma has been developed that Clinical Directors are asked to complete and return prior to the review meeting. The format of the review is a structured discussion around the completed proforma.

The specialty prescribing review comprises several elements:

a.   Drug budget information

Gathers information on whether the specialty receives and regularly discusses their drug budget information.

b.   High cost prescribing

Gathers information on whether:

• The specialty team is aware of the cost of high cost medicines and their use by the team.
• The specialty follows guidelines for the use of high cost medicines, these may be local Area Drug and Therapeutic approved, regional or national.

c.   High volume prescribing:

Gathers information on whether any high volume prescribing occurs within the specialty and whether the team is aware of the impacts of such prescribing.

d.   Quality of prescribing

Gathers information on whether the specialty team:

• Reviews any non-formulary prescribing within their area.
• Feels that the local formulary meets their team’s requirements.
• Review antimicrobial prescribing within their area and if the clinical team feels that the local antimicrobial formulary meets their requirements.
• Frequently require to use medicines that are not routinely available in NHS Scotland (i.e. not approved by SMC) and if so examines whether the team feel that they have a good understanding of the local processes for requesting these medicines (e.g. Peer Approved Clinical System tier 1 and 2, Individual Patient Treatment Request and Unlicensed and Off label).

e.   Patient Information

Gathers information on whether the specialty clinical team provide patients with information to support their clinical treatment and the type of information provided.

f.   Outcomes database/recording

Gathers information on whether:

• The specialty has a database to track patient activity and record treatment history, adverse effects and treatment outcomes
• The specialty’s clinical database assists clinicians in decision making with regards to continuation/discontinuation of medicine

If the specialty has an outcomes database information is gathered on how the database is used: how data is input, managed and whether reports can be provided from the database to help treatment decision making.

g.   Audits

Gathers information on whether regular clinical audits are carried out.

h.   Horizon scanning

Gathers information on the specialty’s awareness of any new medicines/ treatments which will have a financial impact on the organisation in the next 2 – 5 years.

At the end of the review meeting actions to improve clinical and cost effective prescribing are discussed and agreed. The ACEP group follows up to ensure all noted actions are progressed and completed.

NHS Ayrshire & Arran specialty prescribing reviews have highlighted:

• The range and pace of change of treatments available to patients.
• A lack of clinical outcome data recording. Clinical outcome data could be used to review clinical effectiveness of a patient’s treatment.
• Through horizon scanning a range of high cost medicines that require to be considered when planning future drug budgets.
• That clinicians are not fully aware of the drug budget for their specialty, cost of the medicines they prescribe and implications of prescribing on budgets.

NHS Ayrshire & Arran Specialty prescribing reviews are helping the Board to:

• Update training for new consultants to include information on how to effectively prescribe medicines to ensure prescribing is as clinically and cost effective as possible. This training includes provision of information on the work of the Acute Care Effective Prescribing group, prescribing guidelines, cost of medicines within their specialty and availability of HEPMA reports that can aid effective prescribing.
• Look at how to address recording of outcome data and use of this data to ensure patients’ treatment is as effective as possible.
• Highlight any prescribing guidelines that would benefit from review and update.
• Involve clinicians in thinking about cost effective prescribing to aid control of the drug budget.
• Provide information to assist development of robust specialty drug budgets.

Please find attached link to: Clinical prescribing review template