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Put patients at ‘centre’ of script decisions, says NICE guidance

  • 3 Comments

Health professionals should ensure patients are put at the “centre” of decisions about drug prescriptions and medicines management, according to latest clinical guidance.

The National Institute for Health and Care Excellence has called for patients to be more involved in decisions about the medicines they take to help boost compliance and treatment outcomes.

The institute has published new guidance today on medicines optimisation, which highlights that putting people at the centre of care decisions can enable them to use their prescription medicines more “safely and effectively”.

“Enabling patients to take their medicines safely and effectively has been a longstanding challenge for the health service”

Paul Chrisp

Shared decision-making – across health and social care where relevant – should be based on the best available evidence and take account of the patient’s individual needs, preferences and values, the guidelines state.

NICE noted that figures suggest that as many as half of medicines prescribed for patients with long-term conditions are not taken as intended.

The guidance highlighted that there was a greater risk of unintended changes to medicines at the point of transfer between different providers, such as admission or discharge.

When patients moved from one care setting to another, between 30% and 70% of patients have an error or unintentional change to their medicines, it warned.

The guideline recommended that health and social care practitioners should share relevant information about the patient and their medicines when they were transferred between settings.

This should include details of drugs currently being taken, information about allergies and any changes to scripts, including treatments started or stopped, dosage changes, and reasons why.

Ideally, this information should be shared within 24 hours of a patient’s transfer from one care setting to another, said NICE.

NICE also highlighted the importance of carrying out medication reviews, especially for minimising medicines-related problems and reducing waste.

Reviews should take into account the patient’s, or their carers’, views and understanding about their medicines, whether they have any concerns, questions or problems with the drugs.

It should also cover how safe the drugs are, how well they work, how appropriate they are and whether their use is in line with national guidance and, importantly, whether they are likely to provide overall benefit, said NICE.

The guidance called on health professionals to keep an up-to-date list of all the drugs a patient was taking, particularly when admitted, discharged or moved from one ward or hospital to another.

It recommends that checking and listing medicines should be done within 24 hours of the transfer. Meanwhile, when patients are discharged, medicines reconciliation should be carried out no more than one week after their practice receives notification and before a script or new supply of drugs is issued.

The guideline also backs the use of structured, documented plans and patient decision aids for those with chronic or long-term conditions to help them manage their condition using medicines.

“More people are taking more medicines than ever before” said Paul Chrisp, programme director for the Medicines and Prescribing Centre at NICE.

“Enabling patients to take their medicines safely and effectively has been a longstanding challenge for the health service,” he said.

“The NICE guideline on medicines optimisation sets out what needs to be done by all health and social care practitioners and organisations to put in place the person-centred systems and processes required for the optimal use of medicines,” he added.

  • 3 Comments

Readers' comments (3)

  • michael stone

    I wish clinicians would stop using the phrase 'shared decision-making'.

    Other than that, at first glance most of this looks 'sane' - but there is a lot of it, and I won't be digging into it as it isn't my area of interest.

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  • 5 Mar-2015 11:37 am

    one wishes you would stop trolling

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  • michael stone

    Anonymous | 5-Mar-2015 8:25 pm

    Contributing - not 'trolling'.

    I was swapping emails with the authors of a BMJ article (BMJ 2014;350:g7645 doi: 10.1136/bmj.g7645) a week or two ago, and one of the authors had headed one section ‘Shared decision making’. I added a PS to one of my emails:

    PS At the risk of upsetting Glyn, I have an intense dislike of this phrase 'shared decision making' !:

    http://www.bmj.com/content/349/bmj.g4855/rr/761712


    It turns out that he isn’t all that happy with it, either – he sent back:

    you are not at risk of upsetting me - the term shared decision making is not the best - but seems widely used !

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