Primary Care Pharmacy December 2000 Vol 1 No 5 p144-146

News

Realising shared aims in patient care

In recent years there have been a number of Government initiatives which have emphasised the importance of teamworking in primary health care in order to maximise quality and meet patients' needs and expectations. However, teamworking at a practical level within health care settings is more complex and has been more difficult to achieve than is commonly understood. A forum on teamworking in primary care was convened as a result of a joint initiative between the Royal Pharmaceutical Society, the British Medical Association, the Royal College of Nursing, the National Pharmaceutical Association and the Royal College of General Practitioners. Its remit was to examine the practical aspects of teamworking in primary health care and to bring forward proposals by which the national organisations representing primary health care professionals can support and promote the concept.

The forum put together a document that collated evidence to support teamworking in the provision of health care that was beneficial to patients and team members. It highlights and analyses factors that promote or inhibit teamworking, providing examples of team achievements that have succeeded in overcoming obstacles and barriers in order to achieve shared goals for patients. Two sets of recommendations are made — one for teams engaged in hands-on care and another for consideration by national organisations who represent the individual primary health care professions.

Copies of the final report are available on request from Head of Practice, Royal Pharmaceutical Society of Great Britain, 1 Lambeth High Street, London SE1 7JN, Tel 020 7820 3399 ext 305 priced £10 per copy including postage and packing.

The benefits of primary health care teamworking include the provision of:

• A more responsive and patient-sensitive service

• A more clinically effective and/or cost-effective service

• More satisfying roles and career paths for primary health care professionals

Advantages of team care over traditional care identified are:

• Improved organisation and planning

• Avoidance of duplication and fragmentation

• Development of comprehensive databases

• Development of better and more comprehensive health care plans

Barriers to successful teamworking identified include:

• Competing demands of health care professionals

• Diverse lines of management and organisation structures

• Team size and location, which can affect communication

• Time constraints

Factors identified that promote teamworking are:

• Clear team goals

• Rewarding roles

• Effective communication

• Identification of an optimum team size

• Recognition of team members' professional judgment and discretion

• Adequate time and resources

• Shared multidisciplinary learning processes

• Working on team development

Consultation on proposals to extend nurse prescribing

One of the recommendations in the review of prescribing, supply and administration of medicine was to extend the scope of nurse prescribing. In October, the Department of Health issued a consultation document on proposals to extend nurse prescribing to include a wider range of nurses and an extended Nurse Prescribers' Formulary. This will have implications for pharmacists working closely with primary health care teams.

It is expected that the extended formulary might cover:

• Treatment for minor injuries and ailments

• Health maintenance

• Chronic disease management

• Palliative care

Paediatric care and mental health will also be considered. In each case, the competencies and scope of training required by nurses will be identified and a training programme developed.

Five options are suggested for extending the current Nurse Prescriber's Formulary (PJ, November 4, p673). These are:

• No change

• All general sale list (GSL) and pharmacy (P) medicines

• GSL, P and some prescription-only medicines (POMs) to cover certain chronic conditions including asthma, hypertension and diabetes

• All GSL, P and POM drugs but not controlled drugs or a number of specified POMs

• All GSL, P and POMs but not CDs, except perhaps in palliative care

A single formulary, which would rely on nurses making their own judgments about what they feel competent to prescribe, is the preferred option of the Departments of Health. This would simplify the process for pharmacists in the identification of which drugs individual nurses are permitted to prescribe.

The document can be downloaded from the internet at www.doh.gov.uk/nurseprescribing or the Scottish version at www.show.scot.nhs.uk. Comments should be submitted no later than January 10, 2001, in England and January 15 in Scotland.

Pharmacists could improve dermatology services, steering group says

A consultation document about quality care in dermatology could identify opportunities for pharmacists. The document, supported by Leo Pharmaceuticals, says that patients need advice, information and adjustment of treatment to get full benefit from dermatological treatments. The steering group says that social and personal aspects of skin disease are often overlooked and have a bearing on the effectiveness of prescribed treatments.

Most eczema treatment failures have been caused by products not being used, which stemmed from a lack of knowledge on the part of the patient. Problems are particularly great for young children as well as the elderly, who might experience practical difficulties with the application of topical treatments. Prescribers did not have the time to explain everything but suitably trained personnel, such as specialist nurses or community pharmacists, could.

The steering group comprises representatives of the British Dermatology Nursing Group (BDNG), the British Medical Association (BMA), the NHS PCG Alliance, the Primary Care Dermatology Society (PCDS), the Royal Pharmaceutical Society (RPSGB) and the Skin Care Campaign (SCC).

The group is calling for evidence of existing primary care initiatives that demonstrate benefits for patients with acne, eczema or psoriasis. Pharmacists who have experience of initiatives to improve outcomes among patients with dermatological complaints and would like to contribute evidence should telephone 020 7240 6005 and ask for the steering group guidelines. — Contributed.

Error reporting scheme wins joint guild/NPA award

A “no-blame” drug-related error reporting scheme has won the second annual Merck Sharp & Dohme joint award of the Guild of Healthcare Pharmacists and the National Pharmaceutical Association.

The prize winners, a collaboration of community and hospital pharmacists from the Lambeth area and from King's College hospital in London, will be extending Suremed, an error and “near miss” reporting scheme that currently operates at the hospital, to include local community pharmacies.

The system, which focuses on the processes that lead up to errors being made rather than blaming the individual that makes the mistake, will allow community pharmacists to report errors in prescribing, administration and dispensing.

The reports will be analysed by the hospital team and feedback will be provided to local health care professionals via regular alerts and bulletins.

Special alerts will be circulated for recurring problems or problem drugs.

“Extending the scheme will allow pharmacists in primary care to have access to the expertise on error reporting that is available in secondary care,” the prize winners said.

Ms Vanessa Burgess (King's College hospital interface pharmacist and prescribing adviser for South Southwark primary care group), Miss Alice Oborne (pharmacist for evidence-based practice and clinical governance, King's College hospital), Mr Bob Rihal (chairman, Lambeth, Southwark and Lewisham local pharmaceutical committee), Miss Sonia Colwill (principal pharmaceutical adviser, Lambeth, Southwark and Lewisham health authority) and Mrs Gillian Cavell (associate director, pharmacy clinical services, King's College hospital) received the £5,000 award from the President of the Royal Pharmaceutical Society (Mrs Christine Glover). The presentation took place at the headquarters of the Society on November 23 at a ceremony attended by representatives of the guild and the NPA.

Mr Ian Simpson (professional secretary of the guild) congratulated the winners, adding that both their project and that of another recent award winner (PJ, November 18, p744) reflected the increasing interest in error reporting.

Mrs Hilary Edmundson (Brocklehurst Chemists, Hull) gave the audience an update on the project that won last year's award. This was a scheme set up by Mrs Edmundson and Mr Simon Gaines (Hull Royal infirmary) to provide a community pharmacy service to patients needing palliative care. The object was to improve symptom control for patients with a terminal illness who were being treated at home, she said.

Patients had been registered with a pharmacy that they used on a regular basis and the pharmacist monitored the patients prescriptions, discussed symptom control with prescribers and documented interventions in a patient care record.

A training scheme had been developed to bring pharmacists and other members of the multidisciplinary team up to date on palliative care and an emergency drug supply service had been set up to allow health care professionals to have rapid access to medicines.