OLDER PEOPLE


patients admitted with a fall to assess medicine appropriateness, falls risk and any anticholinergic burden or effect on cognition. Where the assessment identified medications that could be contributing to falls, the pharmacist reviewed these medications with the medical team and patient to create a plan of how to reduce this risk through stopping, reducing or changing the relevant medications.


The team also provides post-discharge care with follow-up phone calls to the patient to support them taking their medication at home and to help resolve any post-discharge problems they may have


> practice and community pharmacist to resolve any problems or referring the patients to other services. For example, patients in the bangor and Holywood locality, who are identified as having difficulties managing their medicines, are referred to the Medicines Adherence Pharmacist, who will review and case manage the patient post discharge.’


All of the IC pharmacists are independent prescribers and this has been extremely useful in the management of drug costs through cost-effective prescribing and formulary adherence.


‘The IC Clinical Pharmacy technician has significantly reduced the costs associated with wasted medicines through ongoing stock control and returning unused stock into the system for reissue,’ said Dr Miller.


‘These are medications stopped as a result of the clinical appropriateness reviews and previous to the inclusion of the IC technician in the MOOP team would have been discarded resulting in avoidable waste. Data collection has shown that the appropriate return of medications to SET pharmacy stock from one of the units has resulted in extrapolated saving of £7085 per year, which is to be welcomed in this current economic climate.’


The MOOP team is not, however, totally focussed on medication review. The team also provides a specialised fracture prevention review using bone health risk assessments,


such as FRAX, dietary calcium intakes and vitamin D assessments. A medication-focused assessment tool was developed with input from SET staff users - and with specialist teams from other Trusts - with the aim of driving improvements in reducing falls associated with medication. This tool is currently being tested and refined in the IC setting with plans in place to expand the use of this tool and the falls prevention approach in primary care by working with Practice based Pharmacists (PbPs).


Treatment options are discussed with patients before the IC pharmacist prescribed or altered bone protective medication, made onward referral to, or discussed options with other services, such as DEXA scans, specialist osteoporosis services or community dentists.


‘The service,’ says Dr Miller, ‘ensures that patients are on the appropriate level of bone protection to reduce fractures in a high-risk population and that unnecessary medication is avoided to reduce potential adverse reactions or side effects and rational use of resources.


This information is used to optimise treatment with the aim of reducing the patient’s risk of fractures and providing patients with information on their options so that they are assisted and supported to make informed choices regarding their medicines and treatment options.'


The MOOP team also carried out structured medicine reviews for all


Data collection around the pharmacy team’s holistic approach to falls and fracture prevention showed an improvement in medication appropriateness (MAI) and a reduction in the number of prescribed medications associated with fractures and falls:


Medication appropriate index (MAI) improved upon completion of bone health reviews


No. of drugs associated with fractures and falls reduced


improvements and standardising quality of care, we are sharing the tools that we have developed for medicine review and for fracture and falls prevention. The feedback that we have received is helping to further refine these tools and to influence practice in other areas.’


In addition to medication reviews and fracture prevention reviews, the MOOP team now also manages the seasonal influenza vaccination programme for IC inpatients through verifying patient need, obtaining consent, checking previous administration date/ ADRs, prescribing, ordering and then ensuring that the patients’ GPs are informed when the vaccine has been administered.


6.09 ±7.4 on admission vs. 0.72 ± 1.38 on discharge


4.05 ± 2.0 on admission vs 3.31 ± 1.85 on discharge


The reviews also showed a reduction in the anticholinergic effect of the patient’s medication through reduction in two scoring tools that assess this effect – the Anticholinergic burden (ACb) and the anticholinergic effect on cognition (AEC). The average AEC was lowered from 0.37 on admission to 0.21 on discharge and the average ACb was also reduced from 0.44 to 0.26.


‘Ensuring appropriate bone protection for high-risk patients,’ says Dr Miller, ‘will reduce the cost burden that is associated with fractures, such as hospital admission, surgery, and the need for packages of care post fracture as a result of loss of independence and mobility. We want to help spread good practice beyond the intermediate care team in this regard and so we are heavily involved in providing fracture and falls prevention training to the wider Trust pharmacy team.


‘We have already hosted visits from some of the other IC clinical pharmacy technicians to share the role that the pharmacy technician has developed, such as carrying out the bone health risk assessments, checking dietary calcium intake and prepping the falls risk assessment prior to the medicine review by the IC clinical pharmacist. As part of the team’s aim of spreading


(Wilcoxon Signed Rank test, p<0.05)


(Wilcoxon Signed Rank test, p<0.05)


‘This service,’ says Dr Miller, ‘ensures vulnerable older patients are vaccinated against influenza as per the regional recommendations and helps to prevent outbreaks in the IC setting. This helps to protect the health of the IC inpatients as well as ensuring the IC areas can continue to accept admissions from the acute hospitals to maintain patient flow and reduce bed pressures during the winter season.


‘This year the team introduced a novel approach whereby the MOOP clinical technician carried out the screening and consenting process before the IC pharmacist prescribed the vaccine. With this approach, 78 per cent of patients were vaccinated, meeting the Department of Health vaccination target of 75 per cent for this high-risk population in our care. This project was part of the expansion of the MOOP technician role to include more improvement project work alongside their day-to- day clinical and medicines management duties.’


With report after report concluding that integrated care is the way forward for people living with multiple, complex, long-term conditions, the MOOP teams throughout NI are showing the benefits that ‘joined-up’ and co- ordinated care can bring to this expanding cohort of patients.


PHARMACY IN FOCUS - 13


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