WINNER
‘THIS INNOVATIVE NEW SERVICE IS PUSHING THE BOUNDARIES FOR COMMUNITY PHARMACISTS BY EXTENDING THEIR ROLE AND ALLOWING THEM TO WORK AT THE TOP OF THEIR LICENCE.’
– with additional broad prescribing responsibilities - proved to be a new and exciting challenge for these community pharmacists and allowed them to react to changes in their patients as necessary.
The success of the initiative can be seen in the case of ‘Mrs A’, who is 88 years old and lives in a care home where her family visit her regularly. Mrs A had been living with dementia for several years and was taking some medicines to both help her mood and to help her sleep. Mrs A had a history of high blood pressure, asthma, which didn’t seem to be well controlled, and suffered from chronic pain as a result of osteoarthritis.
She had recently had a few falls in the care home and always seemed to be tired. Her family had noticed that she was less chatty when they visited and care home staff needed to encourage her to eat, occasionally having to help her at mealtimes.
A pharmacist, who was qualified to prescribe medicines, began regular medication review clinics for residents in the care home in addition to the usual GP service.
The pharmacist took a thorough medical and medication history for Mrs A and discussed how she was getting on with her family and with care staff in the home. The pharmacist then discussed potential changes to Mrs A’s medicines and agreed these with her daughter, who is welfare
power of attorney for her mum.
Over a few weeks, the pharmacist prescribed changes to the medicines. He gradually reduced Mrs A’s sedative medicines and stopped the medicines she was prescribed for high blood pressure as her blood pressure was now quite low. These changes made Mrs A less sleepy and less dizzy and her falls subsequently became less frequent.
Since she was now less sleepy during the day, Mrs A began to eat and drink regularly and was more engaged when her family visited.
Since the pharmacist was visiting the care home on a weekly basis, he gradually began to change the pain medicines that Mrs A was taking and monitored the effect. Regular visits from the pharmacist meant that changes to medicines for Mrs A’s long term conditions were made on a gradual basis and were closely monitored. Mrs A’s family were consulted about all changes and were able to meet with the pharmacist at the care home at any time. The pharmacist also worked closely with Mrs A’s GP so that he was aware of all changes to medicines and
could be consulted about changes if needed. Staff in the care home now have a better understanding of the medicines Mrs A is taking and are more cognisant of how to support her with them.
This additional input from the pharmacist prescriber has improved Mrs A’s management of her long term conditions and, in doing so, her quality of life.
Overall, the initiative has been welcomed by all stakeholders involved in the process and feedback from all areas shows that, in addition to improving patient care, the project has improved communication between the care home, GP practice and pharmacy, and has given all parties a better understanding of the risks associated with polypharmacy in this vulnerable, older patient group.
The NHS Lanarkshire model supports community pharmacists in developing the skills required to competently and confidently carry out a holistic medication review as a prescriber and to broaden the scope of their prescribing. This can only be of value for pharmacists working in community who are, by necessity, true generalists, and could be used to enhance the
role of the pharmacist prescriber in community for a vast patient population.
The ‘roll-out’ effect of this model means that any health board could use a similar model to support pharmacist prescribers to become competent in holistic prescribing for medication reviews and so have a skilled workforce at the frontline of healthcare services managing their patients’ medicines at the top of their license.
This innovative new service is pushing the boundaries for community pharmacists by extending their role and allowing them to work at the top of their licence. By consolidating and harnessing their unique skill set, the team is ensuring safe, effective, person-centred and appropriate prescribing for each patient in these care homes and improving their quality of life. The ongoing commitment to these care homes means that patients continue to benefit from the invaluable contribution of these pharmacists and can have their medicines altered appropriately as they reach the end of their lives.
‘RUTH AND PAUL BEGAN TO CARRY OUT HOLISTIC REVIEWS FOR EVERY RESIDENT IN THESE HOMES AND PRESCRIBED THE CHANGES AT EACH PATIENT’S GP PRACTICE ACROSS A WIDE RANGE OF CLINICAL AREAS.’
SCOTTISH PHARMACIST - 33
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