Download Prescribing and QIPP - PrescQIPP

M.O.A.P.A.R.S
Paula Wilkinson
Chief Pharmacist
[email protected]
M.O.A.P.A.R.S
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Medicines
Optimisation
Assessment,
Prevention,
re-Ablement,
Rehabilitation and
Support Service
MOAPARS –what does it do?
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An initial visit to the patient in their own home to assess current medicines management
arrangements within the context of other social care and re-ablement support.
A Medicines Use Review, Appliance Use Review and/or New Medicines Service consultation
as appropriate.
Development, with the patient, of a Medicines Optimisation Plan including review dates and
referral criteria.
Depending on patient need the Medicines Optimisation Plan may include:
– Scheduled regular Pharmacist assessment and review visits.
– Regular or scheduled home visits by a member of the pharmacy team e.g. medicines
administration.
– Other scheduled contact, including phone calls and window cards.
– Promotion of patient-specific healthy lifestyle advice.
– Provision of seasonal influenza and other immunisations as appropriate.
– Information and support for family and/or informal carers.
The above interventions are not exclusive and others may be necessary to meet the needs of
the patient.
• Delivered through a Local
Pharmaceutical Services contract
– Domiciliary service
– Total LPS with right of return to
GPS
– Initially one year contract
– Extension will depend upon
success!
– LPS will include MURs and NMS
but delivered by pharmacists and
pharmacy technicians.
– Skill mix required e.g. drivers
trained in medicines
management
– Stratification of patientsRegistered patients
• Needs to provide service to all
eligible patients across the CCG
Example of patient stories
Mrs SB
age: 90years
1st visit administered flu vaccine, medication reviewed, history taken
(glaucoma, arthralgia,diabetes, hypertension)
Problems - patient constipated and need more lactulose prescribed on her
regular rx, patient using regular OTC ibuprofen for arthralgia not
recommended due to cardiac side effects, excess medication (simvastatin
and travoprost eye drops x 8 months).
Plan: Pharmacy to remove excess medication, GP to review and prescribe
paracetamol (as alternative to ibuprofen), increase lactulose dosing and
amount. Diabetes nurse to review
2nd visit Outcome: patient now has adequate supplies of lactulose, using
paracetamol up to 3 times a day and is pain relief is much improved mobility
improved too, diabetes nurse to visit the next day.
Follow up planned for May
Another example
Mrs JB fills her own dosette boxes with her medication. She has 4 dosette boxes one for
each week. On review these had not been correctly filled.
PRN medication were not affected as Loperamide, Tramadol and paracetamol were not
in the dosette box.
Additionally Mrs JB did not seem to fully comprehend what each of her medications
were for or when or how to take them. Mrs JB's brother had always helped her with the
medication and filling her dosette boxes but this is no longer the case. Mrs JB had
excessive supplies of all her medication.
Action: Pharmacist with consent removed all excess medication leaving just one month
of patients regular medication. Medication removed included: 5 boxes doxazosin, 3
boxes amlodipine, 29 boxes loperamide, 19 boxes furosemide, 14 boxes alendronic acid
and 12 boxes ciprofibrate.
Pharmacist commenced supply of filled MDS.
and another……
• Mrs EF age: 82
• Under community matron service, see dietician every 2 months has carers
who help with medication and food twice a day.
• referred as smoker so potential to give health promotion and has oxygen so
high risk. Plus has nerve damage in foot so risk of fall.
• 1st visit: history taken (cataract operations LE and RE in 2012, 2xDVT, COPD,
hypertension, arthritis and damaged upper spine, nerve damage to left
foot)
• Problems: patient rx ferrous sulphate unsure why, doesn't take calcium
tablets (calceos) as does not like formulation, finds it hard to take
paracetamol as hard to swallow, has excessive maxidex drops patient no
longer uses as has had procedure and postop appointment with consultant GP still supplying.
• Outcome: GP contacted to change calcium to tablet that is swallowed,
paracetamol changed to caplet and maxidex stopped. Plus blood test to
review renal function and iron.
• 2nd visit: GP has not made any changes.
• GP re-contacted to action recommended changes
Medicines Re-Ablement
• Support for people with poor physical or mental health or a
disability to help them live as independently as possible by
learning or relearning the skills necessary for daily living.
• An approach or a philosophy within homecare services – one
which helps people “do things for themselves, rather than
having things done for them”.
• Patient education and empowerment
• Aids to ‘daily medication living’
• Community support
• Making every contact count