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Pharmacy Service role in
supporting informal carers
Inverclyde Pharmacy Change Plan
Natalie O’Gorman
Background
• The predicted change in demographics will place a significant strain
on health, social care and support services.
• Polypharmacy in the elderly is increasingly being recognised as a
major issue with over 40% of over 65 year olds now on >5
medications.
• Drug-drug interactions, medication errors, non compliance and
adverse drug reactions are all consequences of polypharmacy.
• Adverse drug reactions have been implicated in 5-17% of all
hospital admissions.
• In 2009, NICE reported that approximately 50% of all medicines
prescribed for long term conditions are not taken as recommended.
Background
• Previous local work has shown that medication review supports high
quality, safe, clinically effective and cost effective prescribing.
• Follows a previous local audit of medication reconciliation at the
primary/secondary care interface showing that improving
communication helps reduce discrepancies.
• Assisting patients with managing their medications is now a
significant part of the role of an informal carer.
• There is a need to support informal carers by providing them with
information and advice on the use and administration of medication.
Pharmacy Service
• 0.8 WTE Prescribing Support Pharmacist
• Medication Review as a domiciliary visit
• For patients over 65 years on polypharmacy/ high risk medicines to
reduce avoidable medication–related issues in primary care and hospital
admissions for avoidable medication-related issues
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0.6 WTE Prescribing Support Technician
Medicine Reconciliation.
Compliance needs assessment.
Face-to-face medicine concordance and medicines reconciliation
reviews for recently discharged patients over 65 years and to liaise with
other services to ensure changes during admission are implemented in
community and to support elderly patients to manage their medicines in
their own home.
• Based within the Prescribing Team, Port Glasgow Health Centre.
How does the service support
informal carers?
• Gives carers the opportunity to ask questions about the conditions
and medicines of the individual they care for.
• Assists carers at the point of discharge by communicating with the
hospital ward, GP practice and community pharmacy to ensure
correct and timely follow on prescriptions and supply.
• Reduces polypharmacy and improves medicines safety through
medication reviews to ensure that each medication has a current
and valid indication, all monitoring is up to date and where
appropriate, reduce the dose or dosing frequency of the medication.
….
• Reduces confusion and potential harm through the isolation of
expired, discontinued and stockpiled medications for return to a
community pharmacy.
• Aids compliance with medication by recommending formulation
changes. The service can review all the medications in a patient
with a swallowing difficulty and where possible recommend changes
to a licensed soluble or liquid preparation or give guidance on what
medications can be crushed and how to correctly administer them.
• Supplies and provides counselling for a variety of compliance aids
e.g. reminder charts, dosette boxes, eye dropper aids and inhaler
aids which promote independence in the patients they care for.
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• Links with and sign posts carers to other services e.g. community
pharmacy collection and delivery services, social work, community
alert alarms, sensory impairment.
• ?? Offer medication review to carers themselves.
Example Case 1
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72 year old female.
Lives with husband.
6 week admission (HDU).
11 changes to medications.
Significant changes to
antidepressant and anxiolytic
medication.
Discharged with one week supply
of medication in a dosette box.
Discharge Rx posted to GP from
ward.
Discharge Medication
Medication at home
Metformin 500mg BD
Metformin 500mg BD
Aspirin disp. 75mg mane
Aspirin disp. 75mg mane
Atenolol 25mg mane
Atenolol 25mg mane
Senna two nocte
Senna two nocte
Peptac liquid 10mls QDS
Peptac liquid 10mls QDS
Atorvastatin 40mg nocte
Atorvastatin 40mg nocte
Amlodipine 5mg mane
Amlodipine 5mg mane
GTN spray two puffs prn
GTN spray two puffs prn
Diazepam 2mg prn
Diazepam 5mg TDS prn
Furosemide 40mg mane
Ramipril 2.5mg mane
Nicorandil 10mg BD
Dicycloverine 10mg TDS
Co-dydramol 10/500mg
Pericyazine 2.5mg
Case 1 contd.
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Husband normally fills dosette box.
Husband also been unwell (admission to hospital).
No copy of discharge summary at GP surgery.
PHARMACY TECHNICIAN
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Copy of discharge summary taken to GP for amendments to electronic
record and prescription generation.
Discontinued medication removed from home.
Communication with community pharmacy re new dosette box and
delivery.
Counselling provided on medication indications and administration.
Follow up visits / phone calls to patient.
Example Case 2
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83 year old male
Lives with wife.
PMHx – Insulin dependent diabetes, Angina, Osteoarthritis
On 14 repeat prescription medications.
Neuropathy in hands.
Finding it difficult to access medication.
Can’t drive now and has difficulty getting on and off public transport
so wife walking to get medication.
• Dosette box arranged with local pharmacy.
• Medications will be delivered.
Summary
• Change Fund Pharmacy Service – medication review and medicines
reconciliation to support patients and carers in managing medicines
• Aim to reduce avoidable medicines-related issues in primary care
and avoidable medicines-related hospital admissions
• Challenges – to focus medication review on patients/carers who
benefit most and developing referrals to new medicines
reconciliation service
• Pharmacy Input/Presentation to Carer’s Network – in line with
CHCP Carer’s strategy and innovative Pharmacy service
• Assessment – intervention database and working with CHCP to
assess impact