Improving Inhaler
Technique through
Community
Pharmacy Service
Greater Manchester
Area Team
January 2015
www.england.nhs.uk
Service
Specification
www.england.nhs.uk
Service Details
• Built upon the MUR/Prescription Intervention advance
service
• Any patient eligible for a Prescription Intervention can
be invited to join the scheme
• Patients newly prescribed an inhaler should receive
inhaler technique training via NMS- outside of this
project
• Patients entitled to one PI; one brief intervention and
one MUR in a 12 month period
www.england.nhs.uk
Service Details
• The pharmacist will provide an augmented Medicine Use
Review (MUR)/prescription intervention (PI) service to
patients on inhaled medication for the treatment of asthma
or chronic obstructive pulmonary disease (COPD).
• There is no age restriction for patients, but the service
must be provided directly to the patient, not to the
parent/carer on the patient’s behalf.
• The pharmacist will assess the patient’s disease control,
inhaler technique and provide health promotion information
(e.g. smoking cessation advice). The pharmacist will
perform a prescription intervention on eligible patients with
a follow up brief intervention 6-8 weeks later.
www.england.nhs.uk
Service Details
• The brief intervention must be completed on the Improving
Inhaler Technique through Community Pharmacy- Brief
intervention form. The form can be downloaded from the
Community Pharmacy Greater Manchester website,
http://psnc.org.uk/community-pharmacy-greatermanchester/.
• The pharmacist must capture all of the information present
on the brief intervention form, and transfer the relevant
information onto the PharmOutcomes module. The form
must be kept with the assessment form in the pharmacy’s
standard MUR records for post payment verification
purposes. The form must be kept for a minimum of two
years from the date of consultation. A copy of the form
must be sent to the patient’s GP practice.
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Inhaler Technique Patient Pathway Flow Chart 1
Step One Patient on inhaled
medication and meets the standard
requirements for a MUR.
Step Two Patient asked the
complete the ACT/CAT assessment.
Is the score ≥ 20 for ACT or ≤ 10 for
CAT?
Yes
Patient
demonstrating good
control, but may have
poor technique. See
flow chart 2
No
Step Three Patient invited to
participate in inhaler training
Patient not had full MUR in last 12 months
Prescription Intervention undertaken
on inhaled medications only- claim
via FP34c
6-8 weeks later
Brief intervention follow up checkclaim via PharmOutcomes
Full MUR within 12 months- claim
via FP34c
www.england.nhs.uk
Patient had full MUR in last 12 months
Prescription Intervention undertaken
on inhaled medications only- claim
via FP34c
6-8 weeks later
Brief intervention follow up checkclaim via PharmOutcomes
Inhaler Technique Patient Pathway Flow Chart 2
Patient has an ACT/CAT score ≥ 20
for ACT or ≤ 10 for CAT?
Inspiration rate checked using InCheck® device
In-correct inspiration rate
demonstrated
Correct inspiration rate
demonstrated
Does the patient
meet the standard
requirements for an
MUR?
Follow Flow Chart 1
from Step Three
Yes
Perform MUR- claim
via FP34c
www.england.nhs.uk
No
Patient to be invited back
for an MUR when meets
national eligibility criteria
Service Details
• Required data and patient consent to be captured on
consultation form(s)
• Information to be entered on to PharmOutcomes
• Consultation form(s) to be retained in the pharmacy;
copy to be sent to patients GP
• Payment for PI to be claimed via FP34c (£28)
• Payment for brief intervention generated via
PharmOutcomes (£10)
• Expressions of Interest to provide the scheme has
been circulated to contractors
www.england.nhs.uk
Premises Requirements
• PREM1 to be submitted to AT (if not previously done)
• Intervention to take place in the consultation room
• Telephone interventions are not allowed
• Offsite consultations are permitted, apply to the AT via the
standard NHS England procedure
http://www.england.nhs.uk/pharm-adv-serv/
• Signed SLA submitted to AT
www.england.nhs.uk
Pharmacist
Accreditation
www.england.nhs.uk
Pharmacist requirements
• Accredited to undertake MURs
• Undergone face to face inhaler technique training since
2011
• Completed the Declaration of Competence for Improving
Inhaler Technique through Community Pharmacy – now
available at:
• https://www.cppe.ac.uk/services/declaration-ofcompetence
www.england.nhs.uk
Declaration of Competence
• Launched – December 2014
• Pharmacists that have undergone face to face inhaler
technique training are able to start and accredit
retrospectively
• Contractors have been informed DoC available,
pharmacists providing the service will have 2 months after
launch to complete
• Copy of DoC to be kept in the pharmacy
www.england.nhs.uk
Top Tips
www.england.nhs.uk
Top Tips for Respiratory MURs
1. Check the patient’s PMR for frequency of ordering of
medication before starting the review.
For patients with asthma
• Ordering more than twelve short-acting reliever inhalers
over the last year may indicate poor control and that
preventative treatments need to be stepped up.
• Generally patients with asthma should require thirteen
inhaled corticosteroid (ICS) preventer inhalers per year
(might be less for 200 dose metered dose inhalers).
• Is the patient prescribed a long-acting beta 2 agonist
(LABA) without an ICS? This requires a review of the
regimen.
www.england.nhs.uk
Top Tips for Respiratory MURs
2. What does the patient know about their condition and its
treatment?
3. Has the patient had a review before? Who did the review?
Does the patient see anyone else for their condition?
Explain that the reviews are being done with the
knowledge of GP practices in the area and that the aim is
to improve medicines use for respiratory conditions.
4. Check adherence with the information from the PMR and
document any reasons for non-adherence e.g. difficulty in
using device, side-effects, perception of ineffectiveness,
lack of knowledge of indications for different inhalers.
Does the patient experience any problems taking / using
their medicines?
www.england.nhs.uk
Top Tips for Respiratory MURs
5. Assess inhaler technique - use In-check device.
Would the patient benefit from a device switch,
adding a spacer? Does the patient have the same
devices i.e. MDI or Turbohaler?
6. Does the patient know how to take other medicines
prescribed for their respiratory condition e.g. rescue
packs of corticosteroids / antibiotics, mucolytics or
theophylline for COPD.
7. Give smoking cessation advice if appropriate.
8. Does the patient need flu or Pneumococcal
vaccination?
www.england.nhs.uk
Top Tips for Respiratory MURs
9. Does the patient have any questions / need more
information about their medicines?
10. Refer patients if they report:
• An increase in exacerbations
• Their symptoms are not controlled
• Side-effects of medicines
• Severe or life-threatening asthma exacerbation
• Haemoptysis- spitting or coughing up blood
www.england.nhs.uk
Questions?
agm.optometrypharmacy@nhs.net
www.england.nhs.uk