Medicines Adherence Support Service Pilot Project Community Pharmacist Training.
-
Upload
jessica-fowler -
Category
Documents
-
view
219 -
download
3
Transcript of Medicines Adherence Support Service Pilot Project Community Pharmacist Training.
Medicines Adherence Support Service
Pilot Project
Community Pharmacist Training
Dr Susan Patterson, Pharmacy & Medicines Management
Adviser, HSCB
Jo Gribben, Pilot Lead, SE Trust
Caroline Johnston, Pilot Lead, Northern Trust
What problems do older people have with medicines?
“Transforming Your Care”: more older people will be managed at home
36% of over-65s take 4 or more medicines for prevention of chronic disease
10% (approx) hospital admissions are due to medication-related problems
50% of people do not adhere to prescribed medication
The only medicine that works is the one that the person takes
SOUTH EASTERN TRUSTSOUTH EASTERN TRUST
VERONICA CLELAND
RESIDENTIAL, DAY CARE AND DOMICILIARY CARE MANAGER
The ChallengesThe Challenges
• Increasing older population
• By 2019 the population of older people between 65 and 84 is projected to grow by 32%
• The population of 85 and over is projected by 2019 to rise by 45%
• Four Localities within South Eastern Health & Social Care Trust:– North Down– Ards– Down– Lisburn
• Localities are divided into geographical patches and staff work in GP aligned Integrated Primary Care Teams.
District Nurses Care Managers
MHSOP(CPNs)
Assistant Care Managers
GP
Social Workers
Open Referral System into Open Referral System into Local OfficeLocal Office
• Referrals allocated to appropriate Service– Signposted out to Community / Voluntary sector– Reablement– Care Manager / Assistant Care Manager Integrated
teams
• The majority of Service users should be referred to Reablement unless they have no Reablement potential
ReablementReablement
• Reablement – focuses on the client’s strengths and abilities to help them regain their independence, re-learning daily living skills or gaining new ones. Packages of care are focused on the short term with the client moving to other forms of Care Providers if further support is still required.
Care ManagementCare Management• Care Management Is a concept which
embraces the key functions of: case finding, care screening, undertaking proportionate, person-centred assessment of an individual’s needs, determining eligibility for service(s); developing a care plan and implementing a care package; monitoring and reassessing need and adjusting the care package as required.
Source: DHSS&PS Circular HSC (ECCU) 1/2010 March 2010
AssessmentAssessment• A person-centred process whereby the needs of an
individual are identified and their impact on daily living and quality of life is evaluated, undertaken with the individual, his/her carers with the individual, his/her carer and relevant professionals.
Source: DHSS&PS Circular HSC (ECCU) 1/2010 March 2010
• Service users assessed Using - NISAT – (Northern Ireland Single Assessment Tool)
Care Plan
• A description of what an individual needs will be met.
Source: DHSS&PS Circular HSC (ECCU)1/2010 March 2010
Care Package
• A combination of services designed to meet a person’s assessed needs
Source: DHSS&PS Circular HSC (ECCU)1/2010 March 2010
Domiciliary Care
• The mechanism for the delivery of domiciliary care is outlined by DHSSPS (2003) and states that people should be helped to live independent lives with safety and dignity in their own homes.
• All agencies providing Domiciliary Care must be registered with RQIA and operate in accordance with regulation.
The Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003 (the Order).
• Article 38 of the Order confers powers on DHSSPS to prepare, publish and review statements of minimum standards applicable to all services including regulated services.
• Domiciliary Care Agencies Minimum Standardsupdated August 2011
http://www.rqia.org.uk/cms_resources/domiciliary_care_standards-%20Aug%2011.pdf
Care ProvidersCare Providers• NISRA figures survey week in Sept 2013
• 4715 service users received domiciliary care services in the SETIn SET
• 15 / 85% split in care provision
• http://www.dhsspsni.gov.uk/domiciliary_care_services_for_adults_in_northern_ireland_2013-2.pdf
Management of MedicinesManagement of Medicines
• Standard 7: • The agency has arrangements in place to ensure that
care workers manage medicines safely and securely.• http://www.rqia.org.uk/cms_resources/domiciliary_care_standards-
%20Aug%2011.pdf
• Requires that staff are both trained and competent to administer medications.
Issues•Receiving current up to date lists of medication at referral•Updating medication lists/ new prescriptions / transcribing whose responsibility??•Multiple forms of medication administration and competency of staff.•Withdrawal of MDS •Environmental issues•Relatives and informal carer’s giving medication along with formal carer’s •Dual medications in homes (Husband & Wife) •2 or more providers
Currently in SEHSCTCurrently in SEHSCT• Domiciliary care workers in the statutory
sector are not trained to administer medications, can prompt / remind / assist under direction of the service users
• Need to address issues of transcribing / updating MAR
• Safety of service users and protection of staff is paramount.
At present we are rolling out a programme of training for the topical administration of medications
Approx 526 domiciliary care staff require training
Training and on-going competency of staff RQIA mandatory standard –3 yearly
On- going work from Regional perspective,
Any Questions?Any Questions?
Medicines Adherence Support Service
Aim: 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
NICE CG 76 (2009): Supporting AdherenceAssess adherence• provide further information on
medicines• discuss with patient
• Intentional? Discuss beliefs / concerns• Non-intentional? Address practical problems
if there is a specific need
• consider case by case• address concerns and needs of the
individual
Monitoring and follow up
Service Model Tested in Pilot Phase 1
Referral Criteria Aged ≥ 65 years old On four or more regular medications Living at home Attending pilot GP + community
pharmacist Suspected/actual adherence issue
Phase 1 LocationsNorthern Trust:•Ballyclare & Ballymoney
South Eastern Trust:•Hillsborough & Lisburn
Total – 8 GP Practices, 22 Pharmacies
Referrals (n=143)
Community Pathway (118) Hospital Pathway (25)
GPs 83 Pharmacists 21Community Pharmacists 23 Staff nurses 3
Social Care Team 3 OT 1
Re-ablement / Community rehab
2
District Nurse / Diabetic Nurse
4
Other 3
Reasons for Referral
Problems removing tablets from packaging Confusion / confused about medications Problems with ordering/collecting medications Recent hospital discharge Not taking medication as prescribed Requesting Monitored Dosage System (MDS)
Non-Intentional Non-Adherence Issues
ClinicalInadequate knowledge of medication regime
Inadequate knowledge of dose/correct technique
Access
Ordering issues
Storage & Disposal issues
Delivery / collection issues
Day to day
Cognitive / memory issues
Dexterity issuesVision problemsPoor swallow
Solutions Implemented
Resolution of clinical queryMedication ListEducation (specific)Disposal of medicationSign post /referral to other teamsSynchronisation of prescriptionsOrdering solutionsAltering medication timingsProvision of a deviceNew / altered care package
Phase 2
Why conduct a phase 2 pilot?
Outstanding issues from phase 1:
• Supporting medicines adherence in a wider population• Developing a better follow up model• More referral pathways
• Commissioning solutions• Medicines lists• Accessibility
Helping people gain better outcomes from medicines
Helping people live longer, healthier lives
Helping people safely avail of care closer to home
Helping people to benefit from advances in treatment and technology
“Making it Better through Pharmacy in the Community” DHSSPS 2014
Phase 2 - Locations
Integrated Care Partnership Areas
South Eastern Trust - Lisburn
Northern Trust – East Antrim
Community Pharmacy Pathway Attend training!
Service Specification & Guidance
Sign contract (HSCB)
Obtain items on stock list
Complete & submit stock claim form (+ receipts)
Organise pharmacy – staff / premises
Stock List
Community Pharmacy Pathway Identify patients
Patient enrolment
Pre-assessment preparation
Assessment (Community Pharmacy Assessment Form)
Implement Solutions
Monitor & Review
Identifying patients - Criteria
Aged ≥ 65 years old On four or more regular medications Living at home Attending pilot area GP Suspected/actual adherence issue
Identifying patients
Patients self-refer PMR - identify from erratic ordering / poor
management Relatives / friends / staff voice concern Health / social care worker voices concern Referrals from pilot lead
Patient Enrolment Information leaflet
Consent form
Arrange appointment
In pharmacy or domiciliary visit Family / carer present if appropriate Patient to bring all medicines & compliance aids
Patient Information Leaflet
Consent Form
Community Pharmacy Assessment Form
Pre-assessment information (medication) Confirm medicines Assessment of adherence Current support arrangements Issues identified solutions Monitoring & follow-up
Pre-assessment information
Obtain an accurate list of patient’s medication• GP record• Pharmacy PMR• Recent hospital discharge letter
Complete demographic information
Pre-assessment information
Verify medication list with patient/carer
Reasons for discrepancies (intentional ?)
Assess patient’s knowledge
Identify side effects / other issues
Assessment (1)
Assessment (2)
15 questions
3 themes
Access Adherence (day to day management) Clinical & patient attitude
NISAT Format(patient-centred)
Complete to reflect assessed person’s perspective:“I am able” “I am able with difficulty”“I am able with assistance”“I am not able”
Assessor & Carer perspective
Assessment (2)
Assessment (3)
• Current arrangements• Summary of Issues identified • Possible solutions, consider with patient
Solution Grid
Assessment (3)
Implement Solutions Education
Advice on storage
Disposal of medications
Synchronisation
Family involvement
Stock Solutions- Complete stock solution claim form - Pill popper- Pill splitter- Haleraid® / Turbogrip®- Eye drop applicator- Re-usable compliance aids (range of sizes)
Personalised (List-based solutions)
• Monthly Claim Form• Medicines Reminder Card/list
• Medicine Administration Record (MAR Chart) * NB for patient/family/informal carer use only
Monitored Dosage System
MUST confirm accuracy of list
Medication Reminder Card
Medication Reminder Card/List Ensure patient / informal carer can use
Check monthly, against prescriptions
Manage changes Monthly
Interim
Medicine Administration Record For patient / informal carer use only Assess if suitable for patient
Record of medications taken / given Issued monthly against prescriptions Manage changes - New chart
Supplementary Chart
Monitored Dosage System Ensure patient can use Check stability of medications (Guidance) 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
Information/referral to other HCPs
• GP- send summary if relevant• Clinical teams (if known)• Social Care• Pilot lead
Telephone / written informationMust make it clear if action needed,
and by whom
Referral to other HCPs
Monitor and Review Follow-up - Approximately 1 month & 3
months post –assessment (page 4)
Changes to circumstances
Solutions still working / appropriate?
Document actions / referrals / changes
Forward completed form to pilot lead
Monitor and Review
Payment model
Payment model
Payment per contract
Payment per patient
Attendance at training, set up of in-house standard operating procedures, provision of evidence of purchase of the minimum MASS stocklist items and signed contract.
£150
Pre assessment preparation.
£20 per new patient who meets the eligibility criteria and gives consent to participate*
Medicines adherence assessment. Completion of community pharmacy MASS assessment tool.
£28 per patient*
Provision of SolutionsA.directly from the dispensary medicines adherence stock list and/orB. if the solution is a personalised (list-based) solution, it must be based on an accurate list of medicines.
A. Reimbursement for stock items provided. Please see section below.
OR B.£40 per patient per month for checking accuracy of
the patient’s medicines list against the new prescription** and providing an appropriate personalised (list-based) for a maximum of 6 months or the duration of the pilot project.
Monitoring and Follow Up
£10 per patient for monitoring at 1 month and 3 months (or appropriate intervals) and providing data to pilot lead pharmacist.
Stock solution claim form
Assessment claim Form
ExamplePromote service in pharmacy
- Poster
- Leaflet in medication bag
Patient identified (daughter concerned)
- recently discharged from hospital
- a lot of medication in the house
Recruitment
Patient information leaflet supplied
Patient agrees
Appointment arranged Patient and daughter to attend pharmacy
Pre-assessment information
Assessment
Consent form signed Medications – including those started in
hospital
Assessment completed
Changes to medication noted
Assessment
Assessment
Solutions Education on new medications Removal of discontinued medications (form) GP – change Atorvastatin to morning Written list of medicines? Synchronise script quantities and dates –
daughter to order meds monthly Re-usable compliance aid – daughter will fill
Solutions
Actions GP – synchronise scripts, amend
Atorvastatin Claim forms
Pre-assessment preparation Assessment Stock solution (compliance aid) ? Personalised MASS solution 1st and 2nd Follow up
?Any questions
jo
Thank you for listening
Caroline Johnston, [email protected] Gribben, [email protected] Patterson, [email protected]