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Small changes, big differences

Prescription dressings

Tower Hamlets PCT

In 2009, Alison Hopkins was employed as Lead Nurse for the Wound and Lymphoedema Service in Tower Hamlets PCT.

Alison was tasked with putting together a business case for a new off-prescription route for dressings, as no solution currently existed.

Her objectives were to reduce the waste of unused dressings, provide quicker access to dressings, and standardise practices such as infection control.

A project team was put together which included representatives from the commissioning pharmacy, procurement staff and NHS Supply Chain. The proposal was for a centralised scheme for community nurses, GP practices and nursing homes.

Research into similar schemes had shown that most took 40 or 50 per cent of dressings off prescription. The Tower Hamlets scheme took 90 per cent of products off prescription for traditional wound care products.

The solution

The business case was signed off giving Alison six months for implementation.

The focus was not about using cheaper products, but about using the most appropriate products in a more timely manner.

Over prescribing of repeat prescriptions was taking place in some areas with some patients’ prescriptions not being reviewed on a regular basis. As soon as the process changed at GP level, and prescriptions were no longer given to these patients, this patient group became visible and accounted for.

The team worked hard to put solutions in place for patients to ensure they got the best care to manage their conditions.

There is now a robust process in place to ensure all patients are known about and regularly reviewed.

Challenges

Some challenges faced by district nurse teams included low IT literacy which meant difficulties in ordering and planning stock. As an interim measure Alison put in place a buffer store to ensure teams had access to emergency stock.

The issue of community nurses struggling to carry dressings on their visits was helped by the home delivery of bulky products to patients, and improved internal processes within the nursing teams.

This new approach also identifies high spend and complex clients, prompting early referral for specialist advice.

Seeing results

Excellent patient survey feedback has shown that quicker access to dressings has resulted in better overall patient care.

Self-caring patients and carers have been given more regular reviews with clinicians and now have the support and training they need to provide effective care.

By the end of the 2013-14 financial year, £600,000 had been saved over a four year period.