When all pharmacists work together …
| In one West Midlands PCT area pharmacists
from the trust, practices and the community work together. Debbie
Andalo reports |
Pharmacists in the West Midlands have co-ordinated
medicines management of elderly patients in the community in an initiative
which brings together
different members of the pharmacy team. The scheme was originally developed
to meet the needs of the National
Service Framework for Older People but pharmacists involved also believe it fits comfortably with the demands
of the new pharmacy contract. They are confident that while other primary
care trusts may be making similar links across primary care to deliver
medicines management, their scheme stands apart because it brings together
PCT, practice and community pharmacists as well as other health professionals.
Pharmaceutical adviser for Redditch and Bromsgrove PCT Sue Lunec said: “I
think what makes our scheme different is the comprehensiveness of what
we are doing in medicines management. We are pulling all the different
strands together.”
Support needed
The initiative is being led by PCT pharmacist Mary Shaw who is supported
by a pharmacy technician, eight practice-based pharmacists and a handful
of community pharmacists. The idea to bring together all the different
pharmacists across the trust to help deliver the medicines management
demands of the NSF came about because of the high number of elderly
patients in residential and nursing homes. Mrs Lunec said: “We
have 1,032 old people living in 18 nursing homes and 17 residential
homes — it’s impossible for one person to do all those
medicines reviews. And although Mary did face–to-face reviews
and made notes for the GP, we felt that some GPs acted on the notes,
while others didn’t.”
The PCT decided to harness support from the practice-based pharmacists,
who between them spend four hours a week in each of the 23 practices.
They provide additional information for the medicine review of patients
registered with the practice living in the homes as well as taking up
the results of individual reviews with the patient’s GP. Mrs Lunec
said: “I think in the past it was this step, the follow through
with the GP, which wasn’t being done properly — especially
if the practice had only one patient in each of 35 different homes.”
Miss Shaw added: “I found that in the past where I was doing the
medicine reviews, in more rural areas where all patients were registered
with one practice, I was able to go through the results of the review
with the GP. But it was not so straightforward in Redditch and Bromsgrove
where maybe a GP had only one patient in a home and it would have taken
me forever to get to all the practices.” Medicines risk assessment
The medicines management programme also focuses on the discharge of
elderly patients from the local community hospital where there are two
wards
for GP patients. Pharmacy technician Susie Hands carries out a medicines
risk assessment before a patient is sent home. She said: “Sometimes
the patient has been in hospital for so long that the medicines have
changed since admission. I look at the patient’s repeat prescription
and compare that with the medicines being taken on discharge. I assess
about six patients a week.”
She gives each patient a medicines information chart which she discusses
with them as well as answering any questions they have about their medication.
She said: “I can also rationalise their medication if they are
confused about it so that it can be given in a different form.” She
relishes the professional satisfaction the new role offers. “I
can see a patient who is unsure about their medication and why they are
on it, and by the time they go home they are able to understand what
they are doing.”
Community pharmacists have also been given a medicines management role
as part of the initiative. Five of the 25 local pharmacies have already
agreed to take on responsibility for managing the medicine management
plan of individual patients in the community in return for an annual
fee. The fee varies from £140 for taking on responsibility for
patient medication within a locked box at home to up to £380 for
detailed monitoring of a patient’s medicines for a year. The fee
comes out of £30,000 the PCT has put aside for recruiting community
pharmacists into the initiative. Mrs Lunec said: “The community
pharmacists have been contracted to do the work. Mary can identify a
problem which a patient may be having with their medication but, again,
because she is on her own she can’t follow things up with every
patient. What our scheme has done has passed on that responsibility to
the community pharmacist and paid them for that responsibility. What
we have tapped into is the reliability of the community pharmacist — they
are always there in the shop.”
Working across the different pharmacy teams in primary care has been
straightforward, according to the project co-ordinator Miss Shaw. She
said: “I worked in the acute trust for 10 years and in the community
for a few years before moving to the PCT so I already knew a lot of the
community pharmacists and had a good relationship with them.” But
as the scheme, which also applies to medicines management of the elderly
in sheltered accommodation, has become well established it is reaching
out beyond pharmacy. Miss Shaw now often gets referrals from care workers
or social workers who are concerned about a client’s medication. “I
had one call the other day about a patient who had to take her medication
three times a day but the carer was only visiting twice a day. I had
a word with the patient’s GP who rearranged the medication to be
taken twice daily. It was as staggeringly simple as that but, in the
past before this scheme was set up, social services wouldn’t have
had anybody to refer to.” Time for new roles
Sharing patient responsibility for medicines management across the
different members of the pharmacy team has also allowed Miss Shaw to
take on
other new roles including monitoring blood pressure of elderly patients
as part of a heart disease audit, and how becoming involved in medicines
reviews can be used to prevent falls in the elderly.
Miss Shaw is confident that the initiative in Bromsgrove and Redditch
could be developed by other PCTs and she had this advice for others keen
to follow its lead: “I think you have to build up respect to start
with and then build up peoples’ confidence in you and let people
know what you can do.” |
