Objective The objective of this review was to assess the improvement in medicines processes in Northern Ireland focusing mainly on secondary care and at the interface with primary care and also to consider the benefits of enabling technologies for the system.

Methods The review was undertaken by examining all of the publications that had been produced together with relevant context articles that framed and supported the requisite process changes together with a synopsis of relevant enabling technologies that were devised. Key outputs were summarised and incorporated into the system review.

Results The optimisation of the medicines process has led to benefits to patients in terms of morbidity and mortality in addition to a reduction in healthcare resource utilisation. Key findings include reduced length of stay, reduced readmission rates, improved Medicines Appropriateness Index, improved Medicines Administration Error rate, positive impact on Risk Adjusted Mortality Index and improved communication across the primary/secondary care interface. Enabling technology solutions were also implemented.

Conclusions The journey from medicines management to optimisation has resulted in significant improvements in the quality and safety of medicines yielding health gain and economy and a return on investment of £5–8 for each £1 invested. The complementary role of pharmacy in the multidisciplinary team has been identified and evidenced. The next steps will be to further integrate with primary care and deliver improvements in medicines processes in that sector together with requisite enabling technologies.