End of Life Services
APTUK Conference 2013
Lisa Wall-Hayes
Specialist Medicines Management Technician,
End of Life services
Friday 7th June
lisa.wallhayes@nhs.net
Hospice care
• What is the first thing that springs into your
head when you think hospice?
Palliative care
• Traditionally mainly patients with a cancer
diagnosis
• Now much more open to patients with other
life limiting illnesses
– Neurological diseases: Motor Neurone disease,
Multiple Sclerosis etc
– End stage heart failure or renal failure
– End stage COPD, HIV etc
Hospice care
• Most hospices have
– In-patient unit
• Complicated symptom management
• End of life
• Respite
– Day Hospice services
• Self management groups
• Specialist days
– Community teams/ MacMillan nurses
– Hospice at Home
• We also have a Multi-Disciplinary team
Hospice care
• Only a tiny proportion of our patient are inpatients
• 14 bedded unit
• 700 active patients currently known to the
hospice
• Majority of our patients treated at home
Preferred place of care/death
• How or where would you like to die?
• Not something we like to think about or talk
about
• Statistics show that most of us if given the
choice do not wish to die in a hospital
• The majority of people say they would prefer
to die at home or a hospice
• However currently most of us die in a hospital
Hospice vs. Hospital
• Required to maintain standards as per hospital,
– CQC, Infection control, etc
• We have a higher ratio of staff
• Patients room within the hospice can be classified as
“temporary residence” so greater freedom allowed for
patients and relatives
• More privacy and flexibility, e.g.
– 24 hour visiting
– Overnight accommodation for relatives
– In-house chefs
• Specialist staff
Infection control lead
We don’t have one of these….
We have one of these……….
Clinical staff
Multi-Disciplinary Team
(MDT)
• Clinical Pharmacists
• Occupational therapists
• Physiotherapists
• Social worker
• Dietitians
• Pharmacy technician
Other hospice staff
• Clinical nurse specialists
• Doctors
• Psychotherapists
• Art therapists
• Counsellors/family support
• Bridges (practical help)
• Spiritual lead
Technician wanted
• 2 Clinical pharmacists providing specialist symptom
management / medication advice
• Both pharmacists :Non-Medical Prescribers (NMPs)
• Increased non-clinical workload, lots of medicines
management work
• Who could replace the Medicines Management
Department of the PCT?
• A pharmacy technician of course
The job: Where do you start?
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Legislative compliance
Policies
Audits
Cost savings
Accountable Officer support
Non-Medical Prescribing
support
• Research
• Service development
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Medicines Information
Governance Committee
Training
Reports
Incidents
Clinical role
Specialist medication
Troubleshooting
Clinical role
• Day hospice patients
• FAB clinic education
sessions
• Medicines
reconciliation
• Home visits
• Adherence issues
• Assistance with
medication supply
issues and prescriptions
• Mobile working in the
community
F.A.B-ulous patients
“Medicines Matter”
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Monthly newsletter
Latest news
Audit results
Incidents
Questions
Did you know?
Community Pharmacy “Specialist
Palliative Care drugs” scheme
Background
• A number of community Pharmacies have
been commissioned across the cluster to stock
a specific list of palliative care drugs which will
be available at all times during their opening
times.
Which palliative care drugs are being held
by the pharmacies in the Birmingham
area?
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Diamorphine ampoules 5mg, 10mg, 30mg, 100mg
Morphine sulphate 10mg & 30mg injection
Hyoscine butylbromide (Buscopan) ampoule 20mg/1ml
Levomepromazine (Nozinan) ampoule 25mg/1ml
Midazolam ampoule 10mg/2ml
Dexamethasone ampoule 4mg/1ml
Haloperidol ampoule 5mg/1ml
Alfentanyl ampoule 500mcg/1ml
Oxycodone ampoule 10mg/1ml
Cyclizine ampoule 50mg/1ml
Metoclopramide ampoule 10mg/2ml
Water for injection 10ml AND Saline for injection 10ml
Saline 1L bag for infusion
How can we help?
“Every moment matters”
What I had to learn quickly
•If it involves drugs in ANY way it’s my job
and if it doesn’t it probably is too
•You can’t fix everything
•Everyday is a school day
•Brown towels are better than red!!!
•AND…………….
Hospice staff
PCPN, Palliative Care Pharmacy
Network
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National organisation
Local networks for pharmacists
Google groups
Peer support
Palliative Care
needs
PHARMACY
TECHNICIANS
Thank you
Any questions?
“Every moment
matters”
“ The question is not
whether we will die,
but how we will live”
Dr J Borysenko
“As a well spent day
brings a happy sleep so a
life well used brings
happy death”
DaVinci
“Every moment
matters”