This quality standard covers the safe and effective use of medicines for all people who take medicines, including people who are receiving suboptimal benefit from medicines.
It does not cover aspects of managing medicines specific to care home settings because this is covered by the NICE quality standard on medicines management in care homes. For more information see the medicines optimisation topic overview.
Medicines optimisation is defined as 'a person‑centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines'. Medicines optimisation applies to people who may or may not take their medicines effectively.
Getting the most from medicines for both patients and the NHS is becoming increasingly important because more people are taking more medicines. Medicines prevent, treat or manage many illnesses or conditions and are the most common intervention in healthcare. However, it has been estimated that between 30% and 50% of medicines prescribed for long‑term conditions are not taken as intended (World Health Organization 2003). This issue is affected by the increasing number of people with long‑term conditions.
In 2012, the Department of Health's Long-term conditions compendium of information: third edition was published, which defines a long‑term condition as 'a condition that cannot, at present, be cured but is controlled by medication and/or other treatment/therapies'. The report suggested that about 15 million people in England have a long‑term condition and the number of long‑term conditions a person has increases with age: 14% of people under 40 and 58% of people over 60 have at least 1 long‑term condition. The presence of 2 or more long‑term conditions in a person is called 'multimorbidity'. In 2008, the number of people with multimorbidity was 1.9 million, but this is expected to rise to 2.9 million by 2018. Twenty‑five per cent of people aged over 60 report having 2 or more long‑term conditions.
Data from the NHS Digital shows that between 2003 and 2013, the average number of prescription items a year for every person in England increased from 13 to 19. With an ageing population, the use of multiple medicines (polypharmacy) is increasing.
In 2013, the Royal Pharmaceutical Society's Medicines optimisation guidance identified 4 guiding principles to describe medicines optimisation in practice and the outcomes it is intended to affect. The 4 principles are:
Aim to understand the patient's experience.
Evidence-based choice of medicines.
Ensure medicines use is as safe as possible.
Make medicines optimisation part of routine practice.
The quality standard is expected to contribute to improvements in the following outcomes:
harm attributable to errors in medication
patient satisfaction with outcomes from the use of medicines
quality of life for people with long‑term conditions
life expectancy for people with long‑term conditions.
NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – safety, experience and effectiveness of care – for a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 3 outcomes frameworks published by the Department of Health:
Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to medicines optimisation.
NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE Pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to people using services. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development. For this quality standard on medicines optimisation, statement 1 relates to patient involvement in making decisions about the use of medicines.
Patient safety is an explicit component of statements 2 and 3 of this quality standard on medicines optimisation, as well as being one of the overarching aims of the whole quality standard.
The quality standard on medicines optimisation specifies that services should be commissioned from and coordinated across relevant agencies encompassing the use of medicines. A person‑centred, integrated approach to providing services is fundamental to delivering high-quality care to people who take medicines in health and social care settings.
The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality medicines optimisation service are listed in related NICE quality standards.
The quality standard should be read in the context of national and local guidelines on training and competencies. All health and social care professionals involved in caring for people who take medicines, or who could benefit from medicines, should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards.
Quality standards recognise the important role families and carers have in supporting people who are taking medicines in health and social care settings. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.