Transcript South Central Respiratory Project

South Central Respiratory
Project
MK Report
10th October 2011
Nikki Hughes
Community Pharmacy Lead
NHS Milton keynes
What worked well for NHS MK?
 Preparation
 Information
 Communication
Background
 In
MK we prescribe £3m of inhalers
annually (estimate)
 We
know that patients do not use inhalers
effectively – wasting much of this spend
 This
project allowed us to measure the
clinical benefit of the pharmacist
intervention at dispensing
Preparation:
we had already ….
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Run an audit in hospital COPD clinic - most COPD
patients did not use their inhalers correctly
Audited inhaler technique of local HCPs - only 7% could
demonstrate correct technique including correct
inspiratory flow rate
Run a local pharmacy project - patients are happy to
access additional support from their pharmacy
Run training events on inhaler technique for pharmacy
teams, GPs, and nurses
Provided In-check dials to all pharmacies and practices
in MK
Run a multidisciplinary audit to get pharmacists to check
inhaler technique when dispensing
Information:
 We
had not been able to measure the
effectiveness of pharmacist intervention
 The
IoW model used symptom control
tests before & after the intervention to do
this
 ESMAQ
reporting tool allowed us to
monitor activity & analyse results real time
ESMAQ allowed…
 The
pharmacists could measure the
impact of their intervention on patient care
 The
scoring helped patients understand
that better technique made them feel
better
 The
PCT could demonstrate the value of
the service to patient care
Communication:
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Real time analysis meant we could influence the
project whilst still underway
Pharmacists could see each other’s activity –
this stimulated healthy competition
Open access to results allowed pharmacists to
measure themselves against their peers
I could identify & tailor support for slow adopters
I could ask trailblazers for top tips of what
worked for them & share these during project
Communication contd
Early on the GPs reported that patients were
claiming that they no longer needed to attend
review appointments there as the pharmacist
had already reviewed them.
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I could refute the reports as 24% of the patients
pharmacists were accessing had not seen a GP or
nurse for over 12 months. The project improved the
reach of messages to these people
I could influence pharmacists to remind patients it
was even more important to go for GP reviews
because improved technique meant that doses
should be reviewed
Now 14 patients have been referred into the service
by the GP / nurse
Communication…..3
 Results
have demonstrated that 37
patients (60%) have improved their
symptom control during the project.
 Where
unexpected results happened
(sometimes scores got worse..) I could
encourage pharmacists to see the bigger
picture, this was normal & not to give up.
Communication ….4
Results demonstrated improved recruitment to
stop smoking support
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28% inhaler users were smokers
28% of these smokers accepted referral
A further 4 patients accepted referral at second
intervention
6 extra 4 week quitters so far
Communication…..5
Patients love it….
A reluctant recruit said
“I didn’t know that – I have learned something today after
all. Thank you”
Pharmacists love it….
“…another targeted asthma MUR who was suffering oral
problems from the preventer inhaler. I suggested using a
spacer and some improvements to her technique. She
was using a reliever 4 - 5 times a week. Now she rarely
uses her reliever and has no oral symptoms. 4 point
increase in ACT score!
Sometimes you get to make a difference!”
And the PCT benefits…?
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We have developed patient leaflets to be used to
highlight individual advice for patients
We will use the “preparation, information &
communication” approach again
We are looking at offering a similar structured
approach to the other target MUR groups…
We are collecting evidence to persuade PCT to
buy ESMAQ next year ….
We will use NMS data (from Pharmabase?)
locally to influence change