PRACTICE


MEDICINE SICK DAY RULES CARDS: DO YOU USE THEM?


MANY HEALTH BOARDS HAVE DISTRIBUTED MEDICINE SICK DAY CARDS TO THEIR PHARMACIES ON BEHALF OF THE SCOTTISH PATIENT SAFETY PROGRAMME. BUT REFLECTING ON YOUR DAY-TO-DAY PRACTICE, DO YOU USE THEM? DO YOU UNDERSTAND THE REASONS FOR USING THEM?


BY MALCOLM CLUBB


NHS Highland developed and delivered Medicine Sick Day cards1


as a


patient safety initiative. Results of their evaluation were presented as a poster at the Royal Pharmaceutical Society annual conference in 2015.


REASONS FOR USING ‘MEDICINE SICK DAY RULE’ CARDS


‘Medicine Sick Day Rules’ were developed to support stopping certain medicines temporarily during a dehydrating illness. Continuing to take these medicines when dehydrated increases the risk of signifi cant adverse outcomes, such as acute kidney injury. These rules are contained in national guidelines2


aimed at health


professionals, but patients are largely less aware of the rules.


The target medicines - such as Metformin, Sartans, ACE inhibitors - are frequently prescribed in patients and this poses a signifi cant risk of


14 - SCOTTISH PHARMACIST


harm. To support promoting the ‘rules’ to patients, NHS Highland have developed a credit-card sized patient information card. The wording and format of the card was drafted by a pharmacist with input from patients, pharmacists and consultants.


EVIDENCE FOR USE


NHS Highland carried out a two- part evaluation on the card. The fi rst evaluation was a quantitative study and used the Survey Monkey tool to seek views on the use of the cards. Responses to this survey indicated that 71 per cent of staff had used the cards with patients.


The second evaluation used a review of hospital admissions for acute kidney failure, a signifi cant adverse outcome of taking listed medicines when dehydrated. Heart failure admissions were also monitored to assess the risk of not re-starting medicines.


Hospital admissions data were


reviewed for nine months after the cards were introduced. The evidence shows that admissions for acute kidney failure had had a small fall, set against a trend of increasing admissions in previous years. It was deemed therefore that the cards were effective. No increase in admissions for heart failure was observed as well, indicating that the cards are safe as well as effective.


DO YOU USE THE CARDS IN DAY- TO-DAY WORKFLOW?


So, now that it is clear the cards are safe and effective, how do you integrate them into your day-to-day workfl ow?


At Craigmillar Pharmacy, we decided to start using the cards on a pilot basis. We initially commenced supplying cards in isolation of the patient information leafl et on Medicines and Dehydration3


that, whilst the conversations were useful, it carried more clout if the patient had further information to read at their own pace at home.


To support identifi cation of patients we try to target classes of drugs likely to cause dehydration on a fortnightly basis, for example ACE inhibitors one cycle, Metformin the next. We tick each relevant drug to the patient at the point of fi nal check and mark bags for a pharmacist consultation. Each patient is spoken to and supplied with the patient information leafl et.


We also record on the PMR that the patients have received a Medicine Sick Day Card, so that we don’t bother them with the same intervention in a short space of time.


Feedback from patients is usually positive and they usually tell you nobody has told them about the concern before. Following the information starting to be used we have already had a couple of patients discuss the issue when seeking advice due to dehydrating illness around when to recommence their medicines.


If you are interested in reading more information on the Medicine Sick Day rules, supporting materials are available on the Scottish Patient Safety Programme website.


REFERENCES . We felt


1 Abstract International Journal of Pharmacy Practice (Poster number 98, page 92)


2 Scottish Government. NHS Scotland Polypharmacy guidance. October 2012. Available at: www. central.knowledge.scot.nhs.uk/ upload/Polypharmacy%20full%20 guidance%20v2.pdf


[accessed 6th May 2016].


3 Medicines and Dehydration Patient information leafl et available at www. scottishpatientsafetyprogramme. scot.nhs.uk/Media/Docs/Primary%20 Care/Medicines%20Sick%20 Day%20Rules%20cards/MSDR_ PatientInfoLeafl et.pdf


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