| Patients and home care staff in Wales are starting to see the benefits
of a joint pharmacy and social services scheme designed to ensure that
medicines are administered safely to those needing help.
The scheme, known as CARMAS (see Panel), involves community pharmacists
liaising with home care managers to develop care plans for administration
of medicines to vulnerable patients. Central to the scheme is the pharmacist’s
role in training and supporting domiciliary care staff.
Cardiff Medication Administration Scheme
· Pharmacist, social services or other health care professional
identifies a patient needing help with their medicines administration
· Home care manager assesses patient need and suitability
· Patient nominates a preferred community pharmacy
· Pharmacist analyses patient medicine information, decides
administration regimen and provides medication administration
record sheet
· Pharmacist informs GP of patient inclusion and co-ordinates
repeat medication
· Pharmacist liaises with home care manager to develop medicines
administration aspect of care plan for the patient
· Trained carer administers medication, monitored by pharmacist
· Pharmacist and home care manager carry out regular review and
feedback to GP as required |
Alan Brookes, a community pharmacist from Cardiff, is one of the pharmacists
who has been instrumental in the delivery of CARMAS. With input from
Mr Brookes, working closely with Cardiff social services, CARMAS is now
benefiting a number of patients in the area, and is gradually being extended
across the city.
“With this scheme we are providing an extra level of care that
patients might not have had before,” Mr Brookes explains. “Being
on the front line, I see patients who are struggling with their medication
and have confusion that may carry on month after month. There seem to
be certain gaps in the community that need to be filled.”
The scheme relies on good communication pathways and exchange of information
about patients’ medication between health care professionals, social
services and care staff. Patients on the scheme benefit from a more rationalised
medication regimen, accurate recording of medicines being taken, managed
ordering and dispensing of repeat medication and supply of medication
administration record sheets and the safe storage and disposal of medicines.
It has been proposed that the scheme keeps patients in their own homes
for longer, avoiding residential care and hospital admissions, and may
also facilitate earlier discharge from secondary care.
Cath O’Brien, now secretary of the Royal Pharmaceutical Society’s
Welsh Executive, was formerly the project manager of CARMAS and helped
develop the pilot in 1999, funded by a primary care development grant.
Ms O’Brien says the scheme was set up because many patients in
the community had problems understanding or self-administering their
prescribed medicines. “There are other examples of similar types
of service model being undertaken throughout the UK, for example, in Norfolk (PJ,
16 August 2003, p196). However, this is the first scheme of its kind
in Wales to be extended from a pilot to implementation throughout
the local health board.”
Six months ago funding was secured from the local health board in the
form of a “
flexibilities special grant” from the National Assembly, which
is available for funding projects at the interface between health and
social care, and more pharmacists are now becoming involved in the project
across the area.
Mr Brookes explains how he has helped develop the pharmacists’ role
in the scheme. “Initially social services staff were initiating
the scheme, but as it has progressed we have started identifying patients
ourselves and referring them back to the doctor through the home care
manager.”
Alan Brookes and Diane Sherlock |
For the pilot the pharmacist was paid an initial set up
fee of £50
per patient, and then £5 per patient per month. This fee is now
being reviewed. Mr Brookes currently has seven patients on his list.
He explains that operating the scheme now fits into his daily routine
without causing too many time restraints. “The initial set up did
take time but now it takes about 15 minutes per month per patient”,
he says. Mr Brookes also meets Diane Sherlock, home care manager, Cardiff
social services, at least once a month so that they can update each other
on each patient, assess the feedback given by the carers, and refer back
to the doctor if needed.
Mrs Sherlock says that having a pharmacist involved in the scheme has
made a great
difference to the patients with whom she has contact. “CARMAS stabilises
the clients, and benefits their families,” she says. “The
difference in some clients can be noticeable in a few days.” Mrs
Sherlock explains that six pharmacies in north Cardiff and two pharmacies
in the Llanrumney area are now running the scheme, and that the catchment
areas are expanding. She says that pharmacists are being individually
recruited to the scheme depending on the patient need in each area. The
scheme is open to all pharmacists which allows patients to continue to
use their preferred community pharmacy.
This scheme also meets the Welsh Assembly Government Joint Planning and Priorities Guidance for the NHS and social services (2001/2–2003/4),
which identifies priorities for social services that include promoting
independence and independent living, supporting families and carers and
protecting vulnerable people.
Maria Witham, also a community pharmacist and current project manager,
co-ordinates, with pharmcists, the engagement of social care services.
She says: “We are beginning to understand the problems that social
services have with providing long-term care for patients and have given
them feedback in return. It also gives us a chance to use our pharmaceutical
training to do something a bit different from what we normally do.”
She describes a patient who was struggling to administer her own medicines
from a medication aid box and was taking doses erratically. The patient
was confused and would call the home care office at least 20 times a
day to ask what time her carers were coming. However, once on the medication
scheme an improvement in the patient’s condition was immediately
noticeable, and since then she has not made one confused telephone call,
and has returned to her usual routine of
attending a day centre. |
The
Pharmaceutical Journal