Introduction Improving the way medicines are used by patients is a pharmacy led area. There is a need to identify areas where patients may be able to use their medications better and by doing so benefit their health and overall experience of the care we offer them.

The process of exploring a patient's medication taking behaviours, known as 'medicines use review (MUR) provides an opportunity to look at areas associated with medication-related problems or adverse drug events (ADE) and agree ways to improve this.

Addressing these types of problems with the patient can have a positive impact on their experience and as a consequence the outcomes of their treatment.

Aims

• To demonstrate how medicines review can offer patients ways to manage their medications that reduces the risk of ADE's and the potential for drug related re-admissions

• To estimate the impact that avoiding re-admission may have on cost

• To demonstrate the extended role of the pharmacy technician in medicines optimisation

Process A team was formed representing pharmacy, doctors and nurses in order to develop a clinical protocol for optimising medicines use. Full consideration was given to the different types of MUR that have been reported. Those focusing on concordance and compliance provided the ideal opportunity for extending the role of the pharmacy technician.

The protocol manages all aspects of optimisation review, using a list of inclusion criteria, a data collection form, vignettes to support the quality of individual MURs and recording output measures using the NPSA risk matrix and the RIO scoring system.

Outcomes and actions Trinity Hospice Research and Audit Group have ratified this protocol.

• - Data will be collected prospectively

• - Review date will be at the point of 50 patients having received a medication review

• - An Interim report will be submitted when 20 patients have received a medication review.