Transcript PTP 16-17 Day 2 Managing your Medicines

Implementation of
Pharmacy Services
William Hollinger
Pharmacy Manager
McCoubrey and Woodside’s Chemist,
Larne
Pharmacy Plus
UCA PRE-REGISTRATION PHARMACIST TRAINING PROGRAMME
Areas To Be Covered
 PHARMACY SERVICES What are they?
 Why are they important?
 MEDICINES OPTIMISATION SERVICES Managing Your Medicines Service
 Medicines Adherence Support Service (MASS)
Pilot
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Emergency Supply Service Pilot

Minor Ailments
Pharmacy Services
 Why
are Pharmacy Services
important?
 Why
is Medicines Management
important?
Pharmacy Services

Transforming Your Care (TYC)
- Increasing and aging Population
- Health service change from Reactionary
Prevention
- Helping to promote patient centred healthcare
- Allow elderly care to occur closer to home for longer
- Allow patients to gain better outcomes from their medicines
- Improving medication compliance and reducing Medicines Wastage
- Better distribution of Health Care- taking pressure of hospitals and
GP surgeries
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Pharmacy is a provider
- Medicines Management and MASS
- Smoking Cessation
- MURs
- Other Non-Commissioned services e.g. obesity management
Making It Better Through Pharmacy In The
Community Strategy Document
MEDICINES OPTIMISATION SERVICES
Managing Your Medicines
“Managing Your Medicines” is a service
commissioned by the Health and Social Care
Board. It is a pharmacy based service provided for
patients who are vulnerable or at risk.
Aim Of The Service
Undertake a clinical medication review to
optimise treatment
 Educate the patient to improve understanding
of the medicines prescribed
 Support the patients to ensure that both OTC
and prescription medicines are used
appropriately
 Liaise with other healthcare professionals in
order to agree and implement measures to
overcome problems the patient may be
experiencing
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Purpose Of The Service
Assist in achieving a safe and cost effective use
of medication
 Improve adherence and compliance
 Increase patient understanding of their
medication regime
 Improve the quality of life of the patient

THIS SERVICE IS PRIMARILY ABOUT
PHARMACEUTICAL CARE AND
UNDERSTANDING
Patient Criteria
Must take four or more medicines OR
 Take any high risk medicines such as
Digoxin, Warfarin, Lithium, Methotrexate,
Phenytoin, Insulin etc

In addition to the above the patient must
also have-
Patient Criteria
Low level of support for managing
medicines OR
 Poor prescription compliance which is
evident from excessive requests for
emergency supplies of medication and a
poor system of ordering of monthly
prescriptions OR
 Been recently discharged from hospital
with a significant medication change
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Process and Paperwork
 Identify Patients
 Consent form and notification to the GP
 Questionnaire- Pre-visit- fill in medication regimen from Pharmacy PMR and
GP prescribing records
- Covers the following- Knowledge of medication
- Ability to use or take medicines
- Discrepancies in products/labels between what is being
used/taken and regimen taken from PMR/Prescribing records
- Opportunity to optimise medicines e.g. brand vs generic or a
medicine no longer required
Process and Paperwork
- Routine of taking medicines- do they remember to take the
correct medicine at the correct time?
- Obtaining medication supplies/ordering prescriptions
- OTC medicines
- Medication storage
- Side effects
- General Health/Disease Management
- Removal of Medicines
- Health Promotion e.g. diet, exercise, alcohol consumption,
smoking?
 Work out management strategy with patient and
communicate this to GP
 Follow-up in 3-4 months if required- again
communicate this to GP
www.hscbusiness.hscni.net/services/2151.htm
Remuneration
Claim forms sent to the Health Board
once a month
 Review 1 = £70
 Review 2 = £40
 Can only do 20 per year
 A separate claim form is sent quarterly
for patients on MDS boxes who have
been commenced on these as part of this
service
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Medicines
Adherence
Support Service
(MASS) Pilot
Aim of The Service
To improve outcomes from prescribed medicines by
ensuring safety and quality in provision of adherence
support for older people who are living in their own
homes
 Adherence- Extent to which the patient’s behaviour
matches the prescriber’s recommendations. The
patient must also agree and support these
recommendations
 50% of people do not adhere to prescribed
medication

The only medicine that works is the one that the
person takes
Barriers To Adherence

Limited organisational skills-
e.g. forgetting to take medicines

Difficulty taking-
Visual impairment
- Limited dexterity- arthritis
-

Patient belief-
e.g. poor understanding, no belief in treatment
regime
Identifying Patients- Criteria
Aged ≥ 65 years old
 On four or more regular medications
 Living at home
 Attending pilot area GP
 Suspected/actual adherence issue

Community Pharmacy
Pathway
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Identify patients
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Patient enrolment
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Pre-assessment preparation
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Assessment (Community Pharmacy Assessment
Form)
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Implement Solutions

Monitor & Review
Implement Solutions

Education
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Advice on storage
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Disposal of medication
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Synchronisation

Family involvement
Stock
Solutions
Medication Reminder Card
Monitored Dosage Systems
Ensure patient can use
 Check stability of medications

www.ukmi.nhs.uk/applications/MDS/
www.webarchive.org.uk/wayback/archive/20130328051333/http://www.bolton.nhs.uk/Library/s
ervices/med_manage/StabilityofDrugsinComplianceAids.pdf
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Issue weekly against monthly scripts
Inform GP - record can be annotated
Arrangements for medications not in MDS
Procedure for changes
Remove old medications from house
PSNI standards - Consultation
Monitor and Review

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Communicate findings and solutions to GP
surgery using the appropriate form
Follow-up - Approximately 1 month & 3
months post –assessment

Changes to circumstances

Solutions still working / appropriate?

Document actions / referrals / changes
The Future?
Currently not able to take on any new
patients as findings from pilot scheme are
collated
 Can claim for monthly prescription
checks on previously recruited patients
(£40)
 If findings favourable could be rolled-out
province-wide
 Overlap with Medicines Management- is
there room for both long-term?

Emergency Supply
Service (ESS) Pilot
Aims of the ESS Pilot
To ensure that patients can access an
urgent supply of their prescription
medicines where they are unable to obtain
a prescription before they need to take
their next dose
 To relieve pressures on OOHs medical
services at times of high demand
 To ensure equity of access to medicines
irrespective of the patient’s ability to pay

Eligibility to take part in
the ESS pilot- Pharmacy
Be located within the Northern LCG area- this is
being extended
 Be open during some or all of the hours when
Dalriada Urgent Care is supplying cover
 Have a valid contract with HSCB for delivery of
the service
 One Pharmacist has attended a training evening
and a suitable SOP for the service is in place

Eligibility to take part in
the ESS pilot- Patient
Patient must be registered (permanently or
temporarily) with a GP practice in the target area
 Patient must have received the previous supply of
the medicine concerned via a prescription from
their GP

Patient Consultation
Should ideally be between the Pharmacist and the patient
 Interviewing the actual patient may not be possible –
professional judgement and consideration of patient’s best
interest should be taken into account in such cases
 Complete the Patient Consultation Form:

- Patient’s details
- Pharmacy details
- Reasons why emergency supply is required
- Medicine name, strength, dose & quantity supplied
- If medicines are not supplied, record the reason(s)
- Patient / patient’s representative to complete declaration on back of
the form
Advice and Information
Service is not purely a supply of medicines service.
 Consultation must include a discussion with patient on:
- Importance of avoiding running out of medicines
- Ordering medicines in a timely manner from the GP
practice
- Planning ahead for weekends and bank holidays
 Patient to complete declaration on back of consultation
form to state that they have received their medicines, have
been briefed on the service and have received advice.
 Can provide a contact number if they are happy to be
called when the service is being evaluated

Supply of Medicines
All medicines, appliances and ACBS products that a patient
currently receives on repeat prescription from their
prescriber, may be supplied.
 Excluded medicines - Schedule 2 & Schedule 3 Controlled
Drugs and Methotrexate
 Pharmacist to make reasonable attempts to ensure that
two successive supplies are not made via this service (i.e.
previous supply was via a prescription from patient’s own
GP)
 Up to a maximum of 5 days treatment (use professional
judgement)
 In the case of insulin, ointments, creams or inhalers, the
smallest pack size available may be supplied. A full cycle
can be supplied of an oral contraceptive

Completion of Paperwork
A Pharmacy Voucher (PV) must be fully completed and
signed by the pharmacist at the time of consultation.
 PV should be endorsed “Emergency Supply”.
 Full directions for the medicine should be written on the
PV.
 PV should be accurately coded.
 The consultation record (from PV) should be attached to
the Patient Consultation Form (store in Pharmacy)
 The PV should be handled in the normal manner and
forwarded to BSO with your prescription submission.
 Normal POR entry must be made to document the
emergency supply
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Useful Tips
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No consultation fee code or other endorsement is
required on PV- paid an initial payment for taking part in
the service and the normal dispensing fee
Communicate supply to relevant GP surgery at earliest
convenience (fax through consultation form)
Fraudulent or suspicious requests should be reported to
Counter Fraud and Probity Services
Pharmacies should not actively promote or advertise this
service
The use of the Electronic Care Record (ECR) is being
piloted in the Ballymena area in relation to this schemethis could be significant for future developments.
Minor Ailments
Aim Of The Service
The aim of the service is to promote selfcare and to divert patients from GP
practices into community pharmacies
 There are three ways in which a patient
can participate in this service
-Self Referral
-Referral by a Pharmacist
-Referral by GP Practice
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Consultation Outcome
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The patient may be given
◦ Advice only
◦ Advice plus treatment from formulary (up to
two products per patient)
◦ Referral to the GP – non-urgent or urgent
Successful Implementation
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Communication
◦ Explain the service to local GP’s, Practice
managers and GP reception staff
◦ Inform patients of availability of the service
Set up SOP and revise it regularly
Current Therapy Areas
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Head Lice
Athletes Foot
Threadworms
Vaginal Thrush
Diarrhoea
Dhobie Itch
Cold Sores
Ear wax
Mouth Ulcers and inflammation
Oral Thrush
Age Limits
The service is only available to patients aged over 3 months.
This is irrespective of whether or not the product licence
covers use in younger children.
Not every medication listed on the service formulary is
suitable for all patients. The service matches the over-thecounter licensed age ranges for the included medications.
The minimum age of a patient that can be treated under the
Minor Ailment Service is 3 months, irrespective of whether or
not the product licence covers use in younger children. For
some medicines, the minimum age limit is greater than 3
months.
Referrals
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Appropriate Referrals-
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All cases of the current Minor Ailment therapy areas
can’t be dealt with over the counter
The OTC product licence tends to match when a
product can be used in the service
e.g.Vaginal Thrush refer if recurrent, if diabetic or if
under 16 or over 60 etc.
Refer to treatment algorithms on BSO website for each
condition
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Inappropriate Referrals- If a GP has made a decision about the medicine a patient
needs, then a prescription must be issued. A GP cannot write
a prescription for one item and refer the patient to the
Service for another named item.
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http://www.hscbusiness.hscni.net/services/2055.htm
NOT JUST A
PRESCRIPTION FACTORY!