PJ Online | MM: How community pharmacists have become involved in palliative care

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Medicines Management
Issue no 6, p7
November/December 2002

Features

How community pharmacists have become involved in palliative care

Three pharmaceutical care model schemes were established in 1999 by The Royal Pharmaceutical Society in Scotland in collaboration with the Scottish Executive. One of the areas targeted was palliative care. Monika Polak (news and feature writer for Medicines Management) investigates how this scheme has involved community pharmacists

The palliative care scheme in Forth Valley Health Board was set up in July 2000 and Fiona Montgomery, a Macmillan palliative care pharmacist at the Strathcarron Hospice, Denny, Stirlingshire, provides clinical support to the pharmacists involved.

She explains that the scheme was aimed at improving the supply of palliative care drugs and at developing pharmaceutical care in the community. "Supply was highlighted as an issue," she says. "Drugs such as midazolam are not usually found within the pharmacy and with these patients, even a short delay [in obtaining them] can be unacceptable. That is why we set up a supply function."

There are 12 pharmacies involved in the Forth Valley scheme — one in each of the LHCC localities, and one extra in Stirling and Falkirk. Money from the global sum allowed the pharmacists to purchase initial stocks of drugs and controlled drug safes. However, there were a number of desirable criteria that pharmacists had to fulfil before they could become involved.

Specialist suppliers

In addition to holding stocks of palliative care medicines themselves, they had to be prepared to supply specialist medicines to other pharmacies in the locality and to act as a resource for other health care workers, such as GPs. They also had to ensure there was continuity of care, meaning that if more than one pharmacist worked in a particular pharmacy premises, both had to be involved. Ms Montgomery adds: "They also had to be prepared to participate in out-of-hours services and peer review sessions, and their remuneration depends on that — they have to attend at least three out of four sessions in a year."

Out-of-hours cover is provided via a local GP co-operative. "If they need to access palliative care drugs out of hours they have a list of phone numbers of pharmacists and there is a written protocol that they follow," Ms Montgomery says. "But they try to use pharmacies that are open late, or those that are most geographically convenient. We have only had two out-of- hours calls so far, so it's not as much of a problem as people might think it is."

As for initial training, all the pharmacists had to complete a distance learning course on palliative care, provided by the University of Strathclyde's Scottish Centre for Post-Qualification Pharmaceutical Education. This course provides 15 hours of continuing education and covers the concept of palliative care, management of common symptoms, drug delivery devices and pharmaceutical implications in palliative care.

Kenneth More's pharmacy in Killearn is one of those involved in the scheme. He says that every pharmacy has a baseline knowledge of palliative care issues, but that getting involved in this pharmaceutical care model scheme and the peer review sessions has helped to broaden his own knowledge of palliative care and to pass it on to others. "Principally what we do is provide a source of palliative care drugs that would not be readily available in your average pharmacy. But we are also considered to be an information resource for other groups — we provide information on what drugs are available from where and how to source them," he says.

In order to stock larger quantities of diamorphine, the pharmacy acquired a larger controlled drugs cupboard. Mr More says: "Although it is a resource we are pleased to have, it is not something we want to publicise to the public from a security point of view, because it makes us more of a target. But we have not changed any security procedures, since these were fairly stringent anyway."

Greater involvement in care

The scheme is slowly moving towards greater pharmacist involvement in the care of palliative care patients and their medicines management. Some of the pharmaceutical care model schemes involve pharmacists handing out care plans to patients, and this is what the palliative care model scheme in Forth Valley Health Board is currently trying to develop. The proposed palliative care plan is being based on a care plan already used with the elderly, which has just been adapted to cover palliative care issues.

Mr More welcomes this but adds: "It will take time. There are things we do already with palliative care patients that could be considered for palliative care plans, but the documentation of this is something we need to get used to. With the gradual increase in our experience and knowledge, doctors and nurses will come to us more readily."

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