A centre for medicines optimisation research and education

Source: NHE Jul/Aug 2017

Dr Yogini Jani, a consultant pharmacist at University College London Hospitals NHS FT (UCLH), discusses a collaboration with UCL School of Pharmacy that aims to transform patient care by making medicines safer and easier to take.

Left to right: Professor David Lomas, UCL’s vice-provost (health); Professor Ian Wong, CMORE’s co-director; Dr Yogini Jani, CMORE’s director; and Professor Marcel Levi, UCLH’s chief executive

Established in May, the Centre for Medicines Optimisation Research and Education (CMORE) will combine the two partners’ experience and expertise in the effective use of medicines, medication safety and pharmaceutical science and build on education and training initiatives. 

Medicines are the most frequently used intervention in healthcare. Modern medicines are effective but also more complex. With the growing number of patients with long-term conditions and an associated increase in the number of prescription items per patient per year, there is also recognition that nearly 30-50% of medicines for long-term conditions are not taken as prescribed. The issues of multimorbidity and polypharmacy were highlighted in a King’s Fund report published in 2013, and ways of optimising the use of medicines by the Royal Pharmaceutical Society in the same year. In 2015, NICE guidance for medicines optimisation identified key priorities for implementation to enable the best possible outcomes from the safe and effective use of medicines. 

Patient safety concerns in relation to medicines due to adverse events, mistakes and communication breakdown during transfers of care between hospital and other care settings are also well recognised. National initiatives, such as the MHRA yellow card reporting system, the NHS Medication Safety Thermometer and a national alert requiring designated Medication Safety Officers, exist to enable reporting and learning to improve safety. However, there is global acknowledgement through the recent announcement of the WHO’s third global patient safety challenge that “unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world”.  

Medicines optimisation is an umbrella term often used to encapsulate a range of principles and activities to help healthcare professionals and patients to get the best from medicines. These include understanding the patient’s experience of medicines and enabling involvement in their own care, ensuring medicines use is as safe and effective as possible, and having systems for identifying, reporting and learning from medication-related patient safety incidents. Medicines optimisation continues to be an important component of improving health service provision as identified in the Carter report. 

CMORE combines the clinical knowledge and experience of the pharmacy department at UCLH with the academic expertise from UCL School of Pharmacy in areas of medicines use and optimisation, pharmacoepidemiology and medication safety, and age-related medicines development and use.  

Research areas and focus 

The centre will focus on informing design, safety and effective and optimal use of medicines through leading research, improvement initiatives and educational development. 

One example of CMORE activities is a research project to explore ways in which specialist medicines can be administered close to home for cancer patients. The work has been funded by the BOPA-PRUK Research Award for developing research capability of pharmacists. The project will benefit patients by providing deeper insights into the barriers and enablers based on patients’ views and opinions, as well as GP perspectives. Depending on the findings, there is potential for better patient experience and less travelling time, and the opportunity to review and redesign cancer services. 

Another research area is improving the use of antibiotics in patients with penicillin allergy. Nearly 10% of the general population claim to have a penicillin allergy, which will affect the choice of antibiotic they may receive. The project has been funded by the Health Foundation through an Improvement Science Fellowship. It aims to develop, test and implement strategies for improvement by studying how well and what information relating to penicillin allergies is recorded, how healthcare professionals choose antibiotics based on the recorded information, and how this might impact on patient safety and clinical outcomes. Outputs will be disseminated and spread via the National Medication Safety Officer Network for wider patient benefit. 

The educational stream of CMORE builds on the Berwick report recommendations to build training and capacity for quality and patient safety sciences. The centre provides placement and research opportunities for undergraduate and postgraduate students from UCL School of Pharmacy, thus bridging the gap between ‘knowing’ and ‘doing’. Going forward, CMORE will provide training and support in research methods and quality improvement approaches to pharmacists and pharmacy staff, and opportunities for inter-professional learning with doctors and nurses. 

Ultimately, CMORE is based on the premise that medicines are fundamental to modern healthcare and require collaboration between patients and healthcare professionals to study, understand, identify and improve so that we can make the most of the medicines that we have.




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