POLYPHARMACY
allow the pharmacist who provided pharmaceutical services to the home to become more actively involved in the medicine management, and to provide some clinical input.'
NHSGGC was obviously interested in polypharmacy in care homes as well and so, when the Health Board let it be known that it was looking for pharmacists to get involved in this pilot, Elizabeth was one of the first to step up.
'One of the main reasons why I became involved in this pilot,' Elizabeth continued, 'was to be able to use my independent prescribing qualification in an extended role and develop my skills within a new client group and care setting. This trial, I quickly realised, would allow me to use my independent prescribing skills once again in looking at polypharmacy in care homes.'
Fortunately for Elizabeth and her fellow pharmacists, who are taking part in the polypharmacy trial, NHSGGC was able to provide funding for this pilot. A sessional fee is paid to each pharmacist and this enables Elizabeth to see four or five patients a month in one of her local care homes and to have protected time to review clinical notes within the practice, as well as the care home.
Although the pilot was due to start in December, it was to be February of this year before Elizabeth was able to carry out her first polypharmacy reviews in a local care home.
'I don't think that any of us were prepared for the time delays that were involved,' Elizabeth said. 'Where some pharmacists had perhaps only one GP surgery, which dealt with one home, I currently work in partnership with seven GP surgeries, comprising around 40 GPs! So, in order to keep things simple, I decided in December to choose some of the GPs I knew best and to whom I spoke regularly.
'Then, in my chosen care home, I had to persuade the staff of the benefits of this approach. Even when I went to the care home on the first occasion, I had to overcome the concerns of the home manager!'
Elizabeth was certainly successful in selling the attributes of both the pilot and of the service that she could provide to the home's residents. In fact, she has been so successful that
the staff now see the value of her coming in, and actually ask her to check the medication for particular patients!
The next unanticipated delay was that in obtaining the permission of the residents to have their medication reviewed. Since the home that Elizabeth chose specialises in dementia, she had to obtain the permission of the patient's family and then, subsequently, that of the resident's GP.
'With any trial or pilot you know that there are going to be teething problems,' Elizabeth said. 'So, even though we'd received the go ahead to start the trial in December, I don't think any of us anticipated the time that would be required to set the whole process in motion. In some cases it has taken weeks simply to obtain either the patient's or the family's permission to proceed!'
The format of the 'clinics' in the care home is obviously not the structured format usually experienced in a GP's surgery. Elizabeth visits the home during the afternoon, carries out the polypharmacy review with the resident and staff, and then writes up her notes in the form of a review sheet, which she subsequently passes on to the resident's GP.
'To be honest, a lot of the time spent with the patient involves checking as to whether they actually need to be taking all of the medicines that they're currently on. One good example would be that of a patient, who is on an antihypertensive drug, and yet their blood pressure (BP) is on the low side. That may be because they have come into the care home on the drug and it has simply continue. Or, it may be that they were perhaps not coping well at home and had a raised BP as they weren't looking after themselves. Then they come into the care home, where they are looked after and their BP settles down. As the pharmacist, I'm simply taking a fresh look at where the patient is with their medication in comparison with where they may have been when they first entered the home. I'm really enjoying being part of this pilot as I feel it's allowing me to use the skills that I had worked hard to attain. This pilot is giving me the opportunity to put them to use again.'
To date, Elizabeth has reviewed 18 patients: five in February, five in
‘WITH ANY TRIAL OR PILOT, YOU KNOW THAT THERE ARE GOING TO BE TEETHING PROBLEMS,’ ELIZABETH SAYS. ‘SO, EVEN THOUGH WE’D RECEIVED THE GO- AHEAD TO START THE TRIAL IN NOVEMBER, I DON’T THINK ANY OF US ANTICIPATED THE TIME THAT WOULD BE REQUIRED TO SET THE WHOLE PROCESS IN MOTION’
March, four in April and four in May. Since the home that she was allocated to operate in has around 40 residents, she still has plenty of scope for further reviews. Unfortunately, however, the pilot service is due to finish in June.
'Once the pilot is over,' Elizabeth concluded, 'all of the information and evidence is going to be gathered together by Elaine Paton, who is the Senior Prescribing Advisor Pharmacy and Prescribing Support Unit GGHB. Elaine will then look over all of the evidence over the summer months and a decision will then be taken as to whether the service should
be continued and potentially rolled out. I sincerely hope it will - from both a personal perspective as an Independent Prescriber, who is once again able to exercise her skills doing something that she enjoys, but also from the patient's perspective, as I believe that this type of review will benefit every resident in every care home.'’ •
SCOTTISH PHARMACIST - 11
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