AWARDS
WORKING IN PARTNERSHIP
supported by
LLOYDSPHARMACY, CUMNOCK HEALTH CENTRE, CUMNOCK
An exciting new project integrating work between primary and secondary care was established in Cumnock to enhance the link between the community pharmacy sector and hospital setting. The project gave pharmacist Laura McKinnell and her team the opportunity to show how the sector is capable of providing a top-class standard of healthcare.
The project was initiated in Ayr Hospital and was focussed on streamlining the ward discharge process. Prior to this new initiative, the ward had been run by GPs, who were based at different practices. As such, there was no set process in place for handling discharge prescriptions, and this not only caused confusion for the nursing staff, but had led to numerous failed discharges.
The overwhelming majority of patients admitted to the ward were elderly and many of them had pharmaceutical care issues. Laura took on a more clinical role, visiting patients on the ward to discuss their understanding, compliance and technique with inhalers, drops, insulin etc. If necessary, she conducted follow-up domiciliary visits after discharge. As a pharmacist, Laura was well placed to flag issues to the relevant healthcare professional and was also able to refer patients to the prescribing support pharmacists within the GP surgeries for polypharmacy reviews, if necessary.
This exceptional quality of care which Laura and the team delivered by working closely with other healthcare professionals was above and beyond what is generally expected of them as a community pharmacy team. There
is no doubt that their enthusiasm and commitment to the project contributed to its success.
‘Initially,’ says Laura, ‘myself and a colleague from another local branch started the project and found a workable solution to the issue and communicated the new process to all parties involved. One of the biggest challenges was bringing together different healthcare professionals, who all work in different ways, to adapt to a new process for everyone with the end goal of enhanced patient care in mind.
‘Due to the patient demographics of the ward, we decided that, in addition to supporting the discharge process, it would be beneficial for us to provide pharmaceutical care to patients admitted to the ward. Upon admission, I took a brief medical history and information on current medication from the patients’ notes. I then tried to speak with everyone admitted to the ward, but I used the notes as a means of prioritising patients if necessary. The nursing staff also flagged patients up to me whom they felt would benefit from pharmacy input.
‘An intervention log was kept to track the success of the project, along with relevant ‘patient stories’, which were used to highlight clinically significant pharmacy input. The benchmark was set prior to the project beginning against the number of datix issues recorded and the outcome was an ongoing measure of the reduction in datix issues against the original number.
‘This project definitely involved a LloydsPharmacy, Cumnock, alongside Steve Bradley, Cegedim UK Group Managing Director
strong partnership between myself, as a pharmacist from the community pharmacy, the community pharmacy advisor, the ward pharmacist, the nursing team and GP practices. For this close partnership working to be successful, communication between all parties involved was key and having well-defined roles within the care of each patient was necessary. We held regular meetings to assess priorities, successes and collaboration between this unique team so that we could provide words of encouragement and support to each other when required.’
Following the successful roll- out of the new process, further discussion between the individuals mentioned above identified a gap in pharmaceutical care due to the elderly demographics of the ward, and it was decided that both pharmacists involved would initiate ward and/ or domiciliary visits as necessary. The visits have proved to be beneficial to many of the elderly patients seen. These visits provide an opportunity for the patients to ask questions and to get more information on their medication in the comfort of their own home, rather than in the busy community pharmacy environment. In addition to the more general advice and education provided to patients, some potentially harmful situations have been intercepted
and then further prevented by the pharmacist. For example, one patient was discharged from hospital as a new blister pack patient. The patient was followed up at home to check understanding and compliance, and it was discovered that she did not understand what the pack contained.
She had been prescribed diazepam twice daily for anxiety, but, while this had been added to the blister pack, the patient had decided to continue taking the tablets she had in the house as she was unsure whether or not they were in the pack. The patient had been admitted to the ward for rehabilitation after a fall at home which had resulted in a fractured hip, and a double dose of diazepam would have put her at a greater risk of falling and causing further injury. This project allowed the pharmacist to identify and communicate this issue immediately to GPs so that any potential problems were quickly eliminated.
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