Proxy Ordering is an online ordering platform where care home staff have been given access to allow access to order the patient's medications on their behalf. This system is directly linked with the patient's GP practice. It generates a task and prompts the staff member(s) of the GP practice to issue the request to be clinically checked before a prescription is then sent to the patient's nominated pharmacy.
The Proxy Ordering project in Derbyshire set out to improve the ordering process of care homes with the aims of reducing medicine wastage. This will also streamline the ordering processes for the care home and GP and help to save their valuable time.
Following a successful piloting for Derbyshire in Derby City, the project was then rolled out across the whole Derbyshire ICB footprint.
My role was to lead, promote and implement the project. I also provided training to Care Homes and GP practices and supported the wider clinical team with any queries which arose.
To date, 173 out of 314 care homes are currently using the proxy ordering online platform, achieving 55.1% enrolment. There were other homes that were set up to proxy ordering but have since closed down. It is a hope that the percentage enrolment can be increased further over the coming years.
When implementing proxy ordering at a care home, individual patient repeat templates are reviewed to ensure safe and cost-effective prescribing. Where potential inappropriate prescribing was identified, this was highlighted an appropriated clinician. For example, a resident was being prescribed Paracetamol capsules with the directions being based on the patient being above 50kg weight. However, their weight on their record was in the 40kg-50kg bracket. Consequently, the patient had been taking the incorrect max amount of Paracetamol, which was highlighted to be corrected.
This will hopefully reduce the inadvertent toxicity of the over prescribing of Paracetamol which could have caused liver issues. I also investigated patients with liquid medication, as I noticed a recurring trend with those that required to take a small amount of daily medication being issued with full bottle(s) prescribed on a monthly basis. Therefore, a considerable amount was being wasted.
Following investigation into each product's shelf life, it was noted that the length of issue duration could be extended. This reduced medication wastage plus prescribing costs. All medications queries and changes were fed back to the home and documented on patient records.
The annualised savings made from 23/24 was £32,733.28. As an unexpected consequence, this project also helped to maintain and further relationships between GP staff and Care Home staff to strengthen even more with patient safety and their well-being.
