Improving the patient experience of information on medicinesHelen Taylor, Pharmacy Technician

Find out some implications of current landscape and drivers

Explore the type of questions people ask

Think about and understand why they are asking

Use some key resources

Discuss some ethical dilemmas

Aims of the session

Francis report

Medicines Optimisation agenda

Review of the Medicines Act

We’re in a recession, darling!

What’s going on

Public enquiry into the events at Mid-Staffordshire Trust, where institutional culture focused on business, targets and the assumption that problems were someone else’s responsibility

The then Secretary of State for Health, the Rt Hon Alan Johnson MP, said:

‘I apologise on behalf of the government and the NHS for the pain

and anguish caused to so many patients and their families by the appalling standards of care at Stafford hospital, and for the failures

highlighted in the report’

Ripples are spreading: GPhC & patient involvement

http://www.pharmacyregulation.org/gphc-council-agrees-actions-response-francis-report

Mandate for Training https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/203332/29257_2900971_Delivering_Accessible.pdf

APTUK Pharmacy Technician Journal– president’s article (PTJ Spring 2013; p4)

The Francis Report

Pharmacy not specifically mentioned – does that mean all is ok?

‘Foster a common culture shared by all in the service of putting the patient first’ - looks a bit like GPhC standard 1 to me

Reflect on your own attitude and behaviour

Take responsibility and be accountable for your words and

deeds

Be prepared to challenge the judgement and actions of

colleagues and other professionals if necessary

Francis report continued

‘Helping patients to make the most of medicines’

published by the RPS in May 2013 http://www.nhs.uk/aboutNHSChoices/professionals/healthandcareprofessionals/your-pages/Documents/rps-medicines-optimisation.pdf

endorsed by NHS England, ABPI, RCN, Royal College of GPs, Acadeny of Medical Royal

Colleges(makes me wonder where our badge is on

the front of it – or why not??)

‘The evidence base..clearly demonstrates there is much to be

done to help patients, public and society more broadly get best

outcomes from medicines’

‘From patients receiving insufficient information about their

medicines to too many hospital admissions caused by ADRs

which could have been prevented, professionals and patients need to

work much closer together to improve the quality of medicines

use’

Medicines Optimisation

Broad principles:Patient focussed

Right patient, right choice of medicine, right time

Holistic approachEnhanced partnership between

health care professional and patient

Looks at how the patient uses their medicines over time:

Prescribing does not mean takingTaking does not mean compliance

Compliance does not mean always

Statistics are disturbing:‘Only 16% of patients take a new medicine as prescribed, experience no problems and receive as much information as they need’

Medicines Optimisation continued

Four guiding principles:

1. Aim to understand the patient’s experience

2. Evidence based choice of medicines

3. Ensure medicines use is as safe as possible

4. Make medicines optimisation part of routine

practice

Have a look at some of the examples for yourself –

medicines optimisation doesn’t have to be difficult!

Medicines Optimisation continued

Principle 2: evidence based choice of medicines

NICE state that if a medicine has a positive appraisal, it must automatically be

included on your local formulary

Make your formulary work for you:

A Place for Everything, and Everything in its Place

Highlander Rules – In the End, there can be Only One

Lean to the Extreme

Web-based so accessible by community pharmacies without

N3 www.leedsformulary.nhs.uk

Medicines Optimisation

Medicines Optimisation

Started in late 1990’s

Re-evaluted, Re-badged, Re-vamped in 2010

cards distributed with all medicines given to patients

Approximately 80 calls and 1 email per month

Patient Helpline at Leeds

Need information and advice about your

medicines?

0113 206 4376Leeds Medicines Information Service

Monday - Friday 9 am - 5pmSaturdays, Sundays, Bank Holidays 9 am - 3

pmmedicines.information@leedsth.nhs.uk

When you contact us, we usually need to know:

• The names and doses of your medicines

• Your unit number …………………………….

· Any medicines or alternative remedies that you buy

What do you think people ask about ?

Patient Helpline continued

some enquiries fit into more than one categorydoes not include the non-clinical queries (signposting)

Patient helpline – types of enquiries

Administration/dosage30%

Adverse effects13%

Availability/supply20%

Complementary medicine2%

Choice of therapy/ cautions/ ci's13%

Identification1%

Interactions15%

Pharmaceutical2%

Medicines in pregnancy1%

Other clinical queries3%

Availability or supply: obtaining further medicines post-discharge unavailability of medicines in the community medicines reconciliation issues (has my diabetes been cured?)

Adverse effects: potential (what’s worrying in the PIL) actual (what to do next)

4 x yellow cards submitted to the MHRA

Choice of therapy/cautions/contraindications what is tablet x for? concern about items in the PIL second opinions

Patient helpline: most common enquiries

Administration/dosage: confirmation of doses changed on admission/discharge when to start/stop a course what time of day to administer x medicine how to give tablets to a baby (!) how to administer small oral doses without a syringe

Others: interactions, including with food, tobacco, illicit medicines and

alcohol medicines for animals (!) non-pharmacy queries e.g. when does home-help visit/ where’s my dinner/ why haven’t my walking sticks been mended?

Patient Helpline continued

Answering: 80% answered within an hour (often at time of call)

most via telephone, some via email/letter, we can text to say

answer is ready so they can call when convenient

< 7% answered more than one day later

(usually complex; sometimes needed to contact manufacturers)

often answered by pharmacy

techniciansor by pre-registration pharmacy

technicians/pharmacists

very similar to hatch/bedside but at patient’s leisure

patients encouraged to read PIL and call back if needed

Patient Helpline continued

Case Studies in groups:

Complementary medicines

Interactions

Adverse reactions

A Mystery

Providing information to patients

Case Studies in groups:

Husband’s prescription

Daughter’s medicine

Travel medicine

Homeopathy

Ethical Dilemmas with information and advice

Thank you for your time.

Did the session meet the aims and objectives?

I would be grateful of any feedback so I can improve my practice - if you want it to be anonymous, the conference organisers can arrange this.

Helen.Taylor@leedsth.nhs.uk

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