EVALUATION
PIONEERING PILOT A TASTE OF WHAT’S TO COME
LAST YEAR, SP LOOKED AT A PIONEERING POLYPHARMACY PILOT, WHICH WAS CARRIED OUT IN SOME OF GLASGOW’S CARE HOMES. WE SPEAK TO ELAINE PATON, SENIOR PRESCRIBING ADVISER AT THE PHARMACY & PRESCRIBING SUPPORT UNIT (PPSU) IN NHS GREATER GLASGOW & CLYDE, ABOUT THE RESULTS OF THE PILOT’S EVALUATION.
P
olypharmacy is a major feature of today’s pharmacy. And nowhere is it more
prevalent than in Scotland’s increasing number of care homes.
With this in mind, in July this year, the Royal Pharmaceutical Society in Scotland (RPS Scotland) launched a refresh of its 2012 report, ’Improving Pharmaceutical Care in Care Homes’ and asked pharmacists for their views and ideas on how this could be achieved.
Perhaps unsurprisingly, Scotland’s progressive pharmacists have already been addressing this issue. Just last year, SP spoke to pharmacist Elizabeth Roddick about a pilot that she was involved in in the NHS Greater Glasgow & Clyde (NHSGGC) board. The pilot involved pharmacists such as Elizabeth utilising their independent prescribing qualification in an extended role by carrying out polypharmacy reviews in local care homes.
‘We initially developed a community pharmacy Local Enhanced Service (LES) to further test a model of care for patients resident within a care home setting,’ Elaine told SP. ‘This would complement existing work undertaken by the Prescribing Support Teams, and also GPs, who provide medication reviews to nursing home patients as part of their locally agreed services.
24 - SCOTTISH PHARMACIST
‘Ten community pharmacists participated in this pilot LES which ran for six months from December 2015 until May 2016 and included non-prescribers, supplementary and independent prescribers.
‘Of the ten participating individuals, three had no prescribing qualification, one was a supplementary prescriber and the remaining six were all practising independent prescribers. The community pharmacist identified patients within a care home, who were suitable for review and then liaised with a designated local prescribing support pharmacist (PSP) for training and support. All reviews were carried out after patient or welfare proxy consent had been obtained.’
The pharmacists involved were required to review five care home patients each month and this was expected to be undertaken within three sessions. The first was to undertake a case review of the medical notes and care home notes, while the second involved the pharmacist visiting the home to undertake the review with the patient and a member of the care home staff and discuss possible recommendations with the PSP before submission to the prescriber for consideration. The final session was then used to follow up and make any changes necessary that had been agreed by the GP.
‘The major aims of the LES,’ Elaine continued, ‘were to not only undertake evaluation of outcomes from medication reviews, but also to advise on efficient and effective processes for delivering medication review and develop sustainable models of working for community pharmacists to provide medication reviews to this target group.
‘The reviews were carried out using the patient’s care notes within the care home in the presence of a nursing member of staff. The pharmacists used the approved polypharmacy tools and documentation to identify any pharmaceutical care issues which were peer reviewed with a nominated PSP before submitting recommendations to the GP for consideration.
‘Uptake of these recommendations provided the basis for the evaluation for the pilot and eight pharmacists returned an evaluation report.’
The pharmacists recorded care issues and actions based on clinical headings for 71 patients:
• Drug therapy issues: 100 drug therapy issues were identified, ranging from inappropriate strengths, rationalising of topical medications, removal of oral nutritional
supplements and aligning dose times. Sixty per cent of these issues were related to inappropriate therapy;
• Safety issues: eight were
recorded and actioned, including five adverse drug reactions;
• Clinical effectiveness: 43 recommendations were made; and
• Cost effectiveness: eleven recommendations.
PARTICIPANT FEEDBACK
‘The participants all provided very positive feedback about their experience with the LES, as well as things to consider for the future. Many of the pharmacists felt that the medication review process had helped to improve their use of their clinical skills and knowledge whilst gaining job satisfaction of knowing that they were positively contributing to improving the quality of care for the patient. In addition, receiving formal training on the medication review process and use of the STOPP/START all contributed to an increased confidence, both in terms of carrying out the review, but also in making suitable recommendations to the prescriber.
Many also felt that they could then review their own patients’ MAR sheets more appropriately and make recommendations using the knowledge that they had gained from the pilot.
Nevertheless, Elaine was also conscious of the fact that some of the pharmacists experienced
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