A unique partnership collaboration in Pennine Lancashire between East Lancashire CCG Medicines Management Team, local GPs, East Lancashire Hospitals NHS Trust Lancashire County Council, and Inspire (substance misuse service) has won a National Patient Safety Award at the PresQIPP National Conference last week. The award was for their achievement in helping to reduce dependence and unnecessary and potentially harmful medication use locally, through the development of an opioid reduction pathway.
The second national award was in the Care Home Category for the work undertaken by the Medicines Optimisation Care Home Team for their work in reducing anticholinergic medication and associated side effects in care home residents.
East Lancashire is one the most economically disadvantaged and deprived areas in the country with high rates of opioid prescribing for non-cancer related pain. Opioids are very good analgesics for emergency related pain and pain management at the end of life, but there is little evidence that they are helpful for the long-term management of pain. They can also cause dependence if used over extended periods, resulting in long-term dependency. Despite this, they are widely prescribed and their use has increased over time.
The teams from organisations across Pennine Lancashire, worked together using evidence-based practice to develop an integrated care pathway to help identify which patients required specialist support and those who could be managed in primary care, by GPs. Clinicians completed the PresQIPP E-learning resources which helped equip them with additional confidence to manage patients on the pathway efficiently and safely. In addition, resource packs were developed which included patient support, information leaflets, and good practice guidance on reducing opioids.
Their efforts have resulted in a 10% reduction in the prescribing of opioids. People in the community who had become dependent on the medication have successfully reduced their levels of opioids, and experienced improvements in their quality of life and family relationships. Many described the programme as a new lease of life. The award noted that this was a fantastic achievement for the teams and primary care who continued to work on this challenging programme throughout the Covid-19 pandemic.
The East Lancashire Medicines Optimisation in Care Homes (SMOCH) Team was awarded winner in the National PresQIPP Care Homes Award for their work in leading a reduction in anticholinergic burden (ACB) in high-risk patients. Medicines with a high anticholinergic burden are prescribed for a range of conditions including Parkinson’s disease, overactive bladder, chronic obstructive pulmonary disease (COPD), nausea and vomiting, depression and psychosis. Adverse effects include constipation, blurred vision, dry mouth, dry eyes, urinary retention, falls, dizziness, sedation, confusion, agitation, delirium, cognitive impairment and increased mortality. Older patients can be especially vulnerable to these side effects. The Anticholinergic Burden (ACB) score is a useful measure to measure the adverse effects of the different anticholinergic medicines where the higher the ACB number, the stronger the anticholinergic effect. Working with partners in ELHT, PCNs teams and in care homes, the key objective was to help clinicians to reduce the impact of anticholinergic drug use. Since this work commenced three years ago, the ACB burden in the frail elderly has fallen significantly thus reducing the risk of falls, morbidity and hospital admissions. This health improvement project has delivered tangible benefits for care home residents’ quality of life. In addition to this team being awarded winner in this category, they were also awarded the peoples choice Gold Award.