AWARD WINNER “BY INCREASING THE
PHARMACEUTICAL CARE INPUT THAT OUR PHARMACISTS GIVE TO OUR PATIENTS, WE HAVE HAD A VERY POSITIVE RESPONSE FROM PATIENTS WHO ENJOY HAVING THE PHARMACIST TAKE TIME TO SPEAK THEM ABOUT THEIR CONDITIONS. WE HAVE ALSO FOUND THAT PATIENTS HAVE STARTED TO CREATE A MUCH CLOSER PROFESSIONAL RELATIONSHIP WITH THEIR INDIVIDUAL PHARMACIST”
use of InCheck devices and peak flow, and the signs and symptoms of uncontrolled asthma. This event was well attended by pharmacists, pre- reg’s and support staff. The training was well received by all attending. We created our own intervention toolkit that mirrored the look and content that of existing PCR tools (warfarin, methotrexate etc).
“This gave pharmacists a structured, but familiar approach that they could use with their patients to identify any issues with inhaler technique or uncontrolled symptoms, and create a care plan for the patient. This could then be reviewed on the patient’s next trip to the pharmacy, and the PCR documented with the outcomes. By creating a tool in such a way, it was well received by pharmacists who enjoy having a structured consultation guide, and has helped integrate the PCR with daily working. Any care issues identified are then transferred onto the PCR which can then be reviewed at each dispensing. This has created an ethic of fully utilising the useful, and so far underused, pharmacy care record.
“By increasing the pharmaceutical care input that our pharmacists give to our patients, we have had a very positive response from patients who enjoy having the pharmacist take time to speak them about their conditions. We have also found that patients have started to create a much closer professional relationship with their individual pharmacist. By supporting pharmacists in this way, many have been re-invigorated in their approach to CMS.”
In addition to the Asthma PCR
tool, the team have come up with a number of tools over the past 6 months that we have implemented to help aid their pharmacists in taking CMS forward such as a Rivaroxaban tool.
“Many of our pharmacists have assessed the majority of their High Risk Medicine patients, and were looking for ways to make similar interventions with other patients presenting in the pharmacy. As a result, Alasdair adapted the high risk medicine assessment for Warfarin, and tailored it to Rivaroxaban. This has allowed us to target another cohort of patients with specific pharmaceutical needs, and ensure key information regarding side effects, dosing and alert cards are communicated with the patient,” Karen adds.
“Within the Davidsons group, we have a large number of community-based patients receiving their medication in disposable compliance aids (cMDS). At the end of 2013/start of 2014, all cMDS patients had a PCR record created to record them as “Complex dispensing patients”. While this gave them a PCR, it didn’t register them for CMS at the time. In reality, these patients are prime candidates for CMS.
“They get regular medication form our pharmacies, they have long term conditions, but obviously have some sort of care issue that required them to be put on a tray. As a result, we identified a real need for these patients to be registered for CMS. By doing this, it would give the pharmacist an opportunity to re- evaluate the patients’ pharmaceutical needs, and identify/rectify any care issues that appeared. In order to help with this process, we developed an aide memoire of points to cover for this specific patient group.
“The PCR gives us a tool to build a profile of this patient. Previously, a new pharmacist can come in and have no idea why a patient is on a cMDS tray, or what issues they have. A lot of this information will probably be known to pharmacists already, some documented on the Davidsons MDS record, some just known but not documented. This gives a chance to create a full, quality patient profile. At the time of implementation, we issued all pharmacists with guidance on care issues common to these patients, and an example PCR that would help them fully complete a PCR record.
The team identified that the New Medicines Service was an under- utilised part of the CMS bundle available to pharmacists. In order to support pharmacists and highlight issues/potential patients for this service, they devised a clinical support tool to help prompt pharmacists to make an intervention.
“We have identified the top 200 medicines dispensed within the company,” Karen adds. For the first 50, Karen listed key counselling points and common side effects, so that the pharmacist would be able to effectively carry out a new medicines intervention for these items.
When developing the Asthma toolkit for use with CMS, they linked in with other professionals and organisations to ensure that consistent advice was being given, and to explain what care issues they would be focusing on in the review.
“This helped ensure that we were complementing the advice given by other HCP, and to ensure the best way of communicating issues that we had. Before starting the Asthma reviews, the pharmacist was in contact with their local GP/prescribing nurses to explain the scope of our service, and show what tools and advice would be used. This helped ensure complete understanding of what we were offering to complement existing surgery-based clinics, and allowed us to relay key messages that were specific to the surgery.
“We also linked in with larger organisations such as Asthma UK, and the NPA, using toolkits developed by them to ensure that we gave the same information and used up to date advice and guidance.”
As part of Alasdair’s role as quality champion, he will be visiting surgeries to promote CMS- not just serial prescriptions, but to help show, and build upon, the interventions Davidsons are making to help their patients
In trying to help promote and increase uptake of serial prescriptions, they are developing a stamp for use in GP surgeries to highlight patients suitable for serial prescriptions. By using this stamp, the GPs would prompt the
pharmacy to register the patient for CMS, and will then see the registration through their system allowing them to issue the next supply on a serial prescription.
By providing a leaflet for GP’s to hand out to patients receiving new medicines, they hope this will encourage patients to ask more of pharmacists when starting medication.
“The key area we have focused on this year is the tools we developed for Asthma patients,” Karen continues.
“Initially, the PCR template and ACT scoring were used on a small cohort of patients to test feasibility and determine suitability of the service. During a two week trial, two pharmacists completed 23 CMS reviews with Asthma patients using our PCR tool. Of these patient, inhaler technique was identified to be an issue for 16 patients (70%), and a total of 37 care issues being identified – ranging from incorrect technique, excessive Salbutamol use, experiencing preventable side effects and interventions being made on smoking patients. 65% of patients were classified as having uncontrolled asthma using the Asthma UK ACT score.
“This was an eye-opener to the care issues that need to be addressed in a huge cohort of patients that we serve, and a real need to give pharmaceutical care to the patients. As a result of the issues we identified in the trial, we were keen to replicate this across the company in conjunction with the training given to the pharmacists. By focusing on a key area, we were able to ensure the pharmacists had the skills, but more importantly, the confidence to approach their patients and make important interventions that resulted in improving the health of many patients.
“It is our intention to continue to roll-out the work that we are doing, focusing on other chronic conditions and giving focused training and tools to allow pharmacists to continue to improve their patient’s pharmaceutical needs.” •
SCOTTISH PHARMACIST - 33
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