AWARD WINNERS
INDEPENDENT PRESCRIBER OF THE YEAR
ALASDAIR SHEARER, DAVIDSONS CHEMIST, MILNATHORT
AS AN INDEPENDENT PRESCRIBING PHARMACIST, ALASDAIR’S PRESCRIBING HAS LED THE WAY FOR DEVELOPING THE USE OF INDEPENDENT PRESCRIBERS IN CHRONIC PAIN IN TAYSIDE. HE CURRENTLY RUNS A VERY EFFECTIVE CHRONIC PAIN CLINIC FROM THE SURGERY IN KINROSS AND HAS A PROVEN SUCCESS RECORD FOR BOTH PATIENT OUTCOMES AND IMPROVEMENTS FOR THE PRACTICE.
Alasdair’s main prescribing role comes from the chronic pain clinic, which he established last year at Loch Leven Health Centre in Kinross. Working with the GP partners and the locality pharmacist within the practice, Alasdair worked to identify patients whose pain needs were not being met.
Through the clinic, Alasdair responds to both direct referrals from the GPs and through searches for patients whose medication is overdue for review, or who are not taking the most efficacious medication.
Alasdair has set up his clinics with 30-minute appointment slots. This gives him adequate time to approach each patient holistically; to take time to understand their complex pain symptoms, look at treatments that have been tried, and engage them in choosing the correct treatment.
Holding his clinics every two weeks allows him to closely monitor patients and respond quickly to patients who are struggling with their medication. Patients have appreciated the time to be seen by someone with a specialist interest. Due to the complex nature
of chronic pain, these patients require intensive prescribing input, alongside medication support.
Improvements in patient outcomes have already been demonstrated in a number of ways including pain reduction scores. Over the course of the last year, Alasdair has seen 24 new patients. Depending on the support and input required, some patients will require more appointments than others. Most patients will see Alasdair an average of five times. Twenty-one of these patients saw their pain score improve.
Of the three patients who didn’t see an improvement in pain score, one patient had pregabalin stopped completely without a worsening pain score; one patient was introduced to a TENS machine, which prevented escalating doses of neuropathic drugs; and one patient was referred on to the chronic pain team as the pain symptoms changed. As an Independent Prescriber, other pharmacists within Davidsons Chemists now work closely with Alasdair when looking for advice.
Historically, Alasdair has had a
Alasdair Shearer, Davidson’s Chemist and Ryan Anderson, Napp Pharmaceuticals
supportive role within Davidsons, driven on best practice for other pharmacists within the chain. He has used innovative ideas to promote patient care, integration in the community and improvements in patient safety in Milnathort. Evidence of sharing these key learnings, and proactively creating tools for improving patient safety and governance was one of the reasons Alasdair’s pharmacy was awarded the ‘Excellent rating’.
As a result, Alasdair was recently given the key role within Davidsons for providing clinical support, and now offers help to pharmacists by phone, visiting pharmacists in their practice to help with particular problems, and providing support and training to improve input into chronic conditions.
A great example of collaborative working started with another one of Davidsons’ pharmacists becoming aware of Alasdair’s pain work. The pharmacist was dealing with a very complex polypharmacy patient following hospital discharge, and was seeking Alasdair’s advice and support. The patient was admitted to hospital following a suspected medication overdose. On discharge, there were concerns about her ability to manage her 34 repeat medications. The hospital had suggested a compliance aid for the patient, but the patient was resistant to this, and the practicalities of providing medication
in this way were challenging. Since chronic pain was a major factor in the patient’s polypharmacy issues, the GP asked for Alasdair’s advice.
Alasdair liaised with the locality pharmacist and the GP to arrange a meeting with them. It was decided that, based on his expertise, he would be the best to review the patient, and this resulted in Alasdair arranging to see the patient himself. After assessing the patient’s symptom control and her compliance with her numerous medication, the patient quickly engaged with Alasdair as he gave her the time she needed to discuss her condition, understand her treatments and agree on an approach to move forward.
It was decided that he would see the patient on a regular basis to support the changes in medication that he had identified. Although the patient will require input from Alasdair for a long period of time for her complex issues, he has already started to reduce her medication and has also reduced the need for breakthrough doses.
SCOTTISH PHARMACIST - 37
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