Using standardised data to improve medicines safety and enhance eMAR solutions

Medicines are life-saving – when used correctly, they empower individuals to manage their health and enjoy a better quality of life. The UK spends approximately £17.4 billion on medications annually, which accounts for 10% of the NHS budget. With the rise in long-term conditions and comorbidities, the demand for medications will keep increasing. Moreover, there are over 237 million medication errors every year in prescribing, dispensing, or monitoring medications. The CHUMS (Care Homes’ Use of Medicines Study) report revealed that 70% of care home residents experienced at least one medication error daily. In light of these challenges, it is evident that sharing the right information at the right time with both health professionals and patients is crucial for improving patient safety, enhancing efficiency, and reducing waste and costs.

Digital technology is a key driver of this transformation. Electronic medication administration record systems (eMARs), such as Camascope’s, allow clinicians and pharmacists to accurately track medicine administration, reducing errors and addressing issues such as illegible handwriting and missed entries. This ensures that the correct medication is administered in a timely fashion. In an NHS case study involving 11 care homes using Camascope within the South West London NHS ICB, significant efficiency gains were demonstrated. For example, the time required to order medication decreased from 2 hours to 30 minutes, and weekly phone calls to the pharmacy were reduced from 4 hours to just 5 minutes. Additionally, morning rounds in care homes were shortened from 2 hours to 1.5 hours. These improvements not only lead to substantial cost savings by reducing administrative burdens but also allow staff to dedicate more time to direct, person-centered care. However, it’s essential to recognise that using standardised data is fundamental to harnessing the full benefits of these systems and improving medicine safety on a broader scale – and this is where PRB standards play a vital role.

For example, PRSB’s Community Pharmacy Standard defines the information that should be recorded by the community pharmacy and then shared with GPs, other healthcare services, and the individual. By including clinically relevant outcomes from pharmacy services, the standard aims to enhance medication safety and support medicines optimisation.

Another PRSB standard, the eDischarge Summary Standard enables hospitals to transfer all relevant patient information, including medications, to GP surgeries, care homes and community services upon discharge. This not only supports the continuity and effectiveness of care, but means the individual doesn’t have to repeat their medication information to each professional throughout their care and treatment journey.

eMAR solutions that adhere to PRSB standards are essential for driving the change in effective and safe medicines management, as well as ensuring continuity of care. By combining the advantages of digital technology with the benefits of the standards, these eMAR solutions significantly enhance communication and care co-ordination. Data standardisation enables more seamless integration between eMAR systems and care planning systems, leading to more joined-up care across GPs, pharmacists and hospitals, ultimately improving patient outcomes.

Camascope’s eMAR solution exemplifies how digital innovation can significantly enhance medication safety and streamline care delivery. By leveraging standardised data, Camascope ensures that healthcare professionals have the accurate, timely information they need to provide the best possible care, contributing to safer, more efficient medication management across the healthcare continuum. Looking ahead, Camascope is planning to implement PRSB standards within its system, reinforcing its commitment to improving patient outcomes and ensuring seamless integration across healthcare services.

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Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.