Hospital Pharmacist Conference New Directions For Pharmacy Reconfiguring and ReEngineering Services

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Hospital Pharmacist ConferenceNew Directions
For PharmacyReconfiguring and Re-Engineering
Services

• Shifting the Balance of Care- Sharing Care with
  Community Pharmacists
• Norman Lannigan
• Lead Pharmacist Acute Care, Mental Health and
  Innovation
• NHS Greater Glasgow and Clyde

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Shifting the Balance of Care- Sharing Care with
Community Pharmacists

• Shifting the Balance of Care NHS Scotland
  Policy
• The New Community Pharmacy Contract in Scotland
• The Modern Hospital
• Current Problems with Medication at the Interface
  of Care
• Sharing Pharmaceutical Care an Opportunity for
  Improvement

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Better Health Better Care

• Help people sustain and improve their health,
  especially in disadvantaged communities, ensuring
  better, local and faster access to health care.

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Building a Health Service Fit for the Future

• Major consultation on the future direction of the
  NHS in Scotland
• Commissioned by previous Scottish Executive in
  response to public concerns
• Consultation led by Professor David Kerr

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Shifting The Balance of Care
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Shifting the Balance of carePatients with Long
Term ConditionsSelf Care and Management
                                               
                     
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The New Community Pharmacy Contract in Scotland

• Minor Ailments
• Public Health
• Acute Medication
• Chronic Medication

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Chronic Medication Service

• Registration of Patients with Long Term
  Conditions
• Remuneration Based on Capitation not Dispensed
  Items
• Range of Services
• Repeat Dispensing With Counselling
• Repeat Dispensing with Clinical Monitoring
• Repeat Dispensing with Prescribing
• Focus on Provision of Pharmaceutical care not on
  Dispensing Medicines

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The Modern Hospital

• More Ambulatory less In-Patient Care
• Elderly Patients with Multiple Long Term
  Conditions
• Decreasing Lengths of Stay
• Rehabilitation at Home
• Access to Care and Patient Safety are concerns

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Problems with Medicines at the Interface

• Reconciliation of medication
• 30 of patients readmitted partly or completely
  due to problems with medicines
• Achieving Concordance
• Patients discharged prior to medication
  stabilisation
• Patients inability to self medicate

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Sharing Pharmaceutical CareA New Model for
Pharmacy Practice

• Identifying pharmaceutical care need and
  formulation of care plans
• Care plans follow patients during their journey
• Partnerships between pharmacists practising in
  hospital and in the community

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Case History1 Mrs McDonald

• Mrs McDonald is a 75 year old admitted to
  hospital with an acute episode of congestive
  heart failure. She is initiated with low dose ACE
  inhibitor with a plan to gradually increase the
  dose until maximum tolerated dose is achieved.
• She is readmitted 12 weeks later with an
  acute exacerbation of her condition. She is
  still taking the same dose of ACE inhibitor as at
  discharge

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Case History 1 Mrs McDonaldSummary of Problems

• Common Occurrence
• Escalation of ACE Inhibitor dose not done
  post-discharge in primary care
• Poor communication and lack of systems
• Lack of clinical input by community pharmacist

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Case History 1 Mrs McDonaldNew Model of
Pharmaceutical Care

• ACE Inhibitor dose escalation included in care
  plan formulated by pharmacist practising in
  hospital
• Care plan communicated to community pharmacist
  with whom the patient is registered
• Community pharmacist reviews clinical progress
  and prescribes escalating ACE inhibitor dose as
  per care plan
• Partnership working with patients General Medical
  Practitioner

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Case History 2 -Mrs Campbell

• Mrs Campbell is an 85 year old admitted to
  the acute medical unit with confusion. She has
  multiple long term conditions including chronic
  obstructive pulmonary disease. Her Hospital
  Pharmacist notes a number of problems with her
  multiple medications including a poor inhaler
  technique. A diagnoses of acute urinary tract
  infection is made and Mrs Campbell is discharged
  from the acute receiving unit with a course of
  antibiotics to her supported care home
  environment.

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Case History 2 Mrs CampbellSummary of Problems

• Elderly lady with multiple long term conditions
  admitted with unrelated acute problem
• Hospital pharmacist identifies a number of
  improvements to her medication regimen and her
  understanding of her medicines which might
  improve her health
• Length of stay too short to implement the
  identified pharmaceutical care plan

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Case History 2 Mrs CampbellNew Model of
Pharmaceutical Care

• Medication problems and pharmaceutical care
  issues identified by pharmacist in hospital who
  formulates a pharmaceutical care plan
• Pharmaceutical care plan follows patient on
  discharge to community pharmacist with whom the
  patient is registered
• Community pharmacist implements pharmaceutical
  care plan in liaison with the patients general
  practitioner
• Community pharmacist visits patient and works on
  developing the patients understanding of her
  medication and improving her inhaler technique

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Case History 3 Mr Gordon

• Mr Gordon is a 75 year old man who is
  admitted for a day case surgical procedure. At
  admission to the day case unit he is found to be
  taking an anticoagulant which has not been
  adjusted prior to his admission. The anaesthetist
  decides to cancel his operation.

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Case History 3 Mr GordonSummary of Problems

• Common occurrence
• Medication not adjusted prior to admission to
  hospital for day case procedure
• Cancellation causes inefficiencies for the
  hospital and distress for the patient

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Case History 3 Mr CampbellNew Model of
Pharmaceutical Care

• Protocols and standard pre-admission
  pharmaceutical care plans developed between
  specialist pharmacist and anaesthetist
• Standard pharmaceutical care plans communicated
  to community pharmacist and training provided
• Community pharmacist made aware that their
  registered patient is scheduled for day surgery
• Medication adjusted according to protocol and
  care plan and patient and General Medical
  Practitioner are fully informed
• Specialist Pharmacist available as point of
  reference for complex patients

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Case History 4 Mrs Glennie

• Mrs Glennie is a 49 year old lady with chronic
  rheumatoid arthritis. She is now receiving
  Anti-TNF therapy prescribed by her hospital
  consultant and supplied through a home care
  company. She takes other multiple medications as
  prescribed by her General Medical Practitioner
  and dispensed by her Community Pharmacist. She
  develops signs of a mild infection for which she
  consults her community pharmacist who suggests
  bed rest, fluids and paracetamol for pyrexia

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Case History 4 Mrs GlennieSummary of Problems

• Sign of infection may be an indication to
  temporarily cease Anti-TNF therapy
• Community Pharmacist not aware patient is
  receiving this therapy
• Community Pharmacist unfamiliar with adverse
  reactions of Anti-TNF therapy
• Patient not educated sufficiently to take greater
  responsibility for own care

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Case History 4- Mrs GlennieNew Model of
Pharmaceutical Care

• Patient initiated Anti-TNF therapy and receives
  this from her Community Pharmacist with whom she
  is registered along with all her other medication
• Shared care initiated by patients specialist
  pharmacist who provides standardised care plan
  and information to Community Pharmacist
• Patient is educated by specialist pharmacist on
  initiation of therapy and is provided with
  written information
• Referral pathways provided for the Community
  Pharmacist and General Medical Practitioner

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Shifting the Balance of Care- Sharing
Pharmaceutical Care with Community
PharmacistsWhat Needs to Happen?

• Conclusion of negotiations of detail of community
  pharmacy contract Chronic Medication Service
• Extension of role of specialist pharmacist
  practising in hospital
• Leadership in developing standardised care plans
  for chronic disease
• Point of reference for Community Pharmacist in
  managing complex patients
• Electronic Communication of Care Plans and
  Medication Records
• Intra and Inter-Professional understanding and
  co-operation

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Conclusion

• Shifting the Balance of Care NHS Scotland
  policy encourages supported self care closer to
  home
• The new community pharmacy contract in Scotland
  offers exciting opportunities for the Pharmacy
  profession
• There is an opportunity for the Pharmacy
  profession to contribute significantly to solving
  common and persistent problems with medicines
  which exist at the interface of care