Improving the patient experience
of information on medicines
Helen Taylor, Pharmacy Technician
Aims of the session
• Find out some implications of current landscape and drivers
• Explore the type of questions people ask
• Think about and understand why they are asking
• Use some key resources
• Discuss some ethical dilemmas
What’s going on
• Francis report
• Medicines Optimisation agenda
• Review of the Medicines Act
• We’re in a recession, darling!
The Francis Report
•
Public enquiry into the events at Mid-Staffordshire Trust, where institutional
culture focused on business, targets and the assumption that problems
were someone else’s responsibility
•
The then Secretary of State for Health, the Rt Hon Alan Johnson MP, said:
‘I apologise on behalf of the government and the NHS for the pain
and anguish caused to so many patients and their families by the
appalling standards of care at Stafford hospital, and for the failures
highlighted in the report’
Ripples are spreading:
– GPhC & patient involvement http://www.pharmacyregulation.org/gphc-council-agrees-actions-response-francis-report
– Mandate for Training
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/203332/29257_2900971_Delivering_Accessible.pdf
– APTUK Pharmacy Technician Journal– president’s article (PTJ Spring 2013; p4)
Francis report continued
•Pharmacy not specifically mentioned – does that mean all is ok?
•‘Foster a common culture shared by all in the service of putting the
patient first’ - looks a bit like GPhC standard 1 to me
– Reflect on your own attitude and behaviour
– Take responsibility and be accountable for your words and deeds
– Be prepared to challenge the judgement and actions of colleagues
and other professionals if necessary
Medicines Optimisation
‘Helping patients to make the most of medicines’
– published by the RPS in May 2013
http://www.nhs.uk/aboutNHSChoices/professionals/healthandcareprofessionals/your-pages/Documents/rps-medicines-optimisation.pdf
– endorsed by NHS England, ABPI, RCN, Royal College of GPs, Acadeny
of Medical Royal Colleges
–
(makes me wonder where our badge is on the front of it – or why not??)
‘The evidence base..clearly demonstrates there is much to be done to help
patients, public and society more broadly get best outcomes from
medicines’
‘From patients receiving insufficient information about their medicines to too
many hospital admissions caused by ADRs which could have been
prevented, professionals and patients need to work much closer together to
improve the quality of medicines use’
Medicines Optimisation continued
Broad principles:
–
–
–
–
Patient focussed
Right patient, right choice of medicine, right time
Holistic approach
Enhanced partnership between health care professional and patient
Looks at how the patient uses their medicines over time:
–
Prescribing does not mean taking
•
Taking does not mean compliance
– Compliance does not mean always
Statistics are disturbing:
‘Only 16% of patients take a new medicine as prescribed, experience no
problems and receive as much information as they need’
•
Medicines Optimisation
continued
Four guiding principles:
1.
Aim to understand the patient’s experience
2.
Evidence based choice of medicines
3.
Ensure medicines use is as safe as possible
4.
Make medicines optimisation part of routine practice
Have a look at some of the examples for yourself –
medicines optimisation doesn’t have to be difficult!
Medicines Optimisation
Principle 2: evidence based choice of medicines
NICE state that if a medicine has a positive appraisal, it must automatically be
included on your local formulary
Make your formulary work for you:
A Place for Everything, and Everything in its Place
Highlander Rules – In the End, there can be Only One
Lean to the Extreme
Web-based so accessible by community pharmacies without N3
www.leedsformulary.nhs.uk
Medicines Optimisation
Patient Helpline at Leeds
•Started in late 1990’s
•Re-evaluted, Re-badged, Re-vamped in 2010
– cards distributed with all medicines given to patients
•Approximately 80 calls and 1 email per month
Need information and advice
about your medicines?
0113 206 4376
Leeds Medicines Information Service
Monday - Friday 9 am - 5pm
Saturdays, Sundays, Bank Holidays 9 am - 3 pm
medicines.information@leedsth.nhs.uk
When you contact us, we usually need to know:
• The names and doses of your medicines
• Your unit number …………………………….
Any medicines or alternative remedies
that you buy
Patient Helpline continued
What do you think people ask about ?
Patient helpline – types of enquiries
•some enquiries fit into more than one category
•does not include the non-clinical queries (signposting)
Other clinical queries
3%
Medicines in pregnancy
1%
Pharmaceutical
2%
Interactions
15%
Administration/dosage
30%
Identification
1%
Choice of therapy/ cautions/
ci's
13%
Complementary medicine
2%
Adverse effects
13%
Availability/supply
20%
Patient helpline: most common enquiries
Availability or supply:
• obtaining further medicines post-discharge
• unavailability of medicines in the community
• medicines reconciliation issues (has my diabetes been cured?)
Adverse effects:
• potential (what’s worrying in the PIL)
• actual (what to do next)
– 4 x yellow cards submitted to the MHRA
Choice of therapy/cautions/contraindications
• what is tablet x for?
• concern about items in the PIL
• second opinions
Patient Helpline continued
Administration/dosage:
• confirmation of doses changed on admission/discharge
• when to start/stop a course
• what time of day to administer x medicine
• how to give tablets to a baby (!)
• how to administer small oral doses without a syringe
Others:
• interactions, including with food, tobacco, illicit medicines and alcohol
• medicines for animals (!)
• non-pharmacy queries e.g. when does home-help visit/ where’s my
dinner/ why haven’t my walking sticks been mended?
Patient Helpline continued
Answering:
• 80% answered within an hour (often at time of call)
– most via telephone, some via email/letter, we can text to say answer is
ready so they can call when convenient
• < 7% answered more than one day later
– (usually complex; sometimes needed to contact manufacturers)
• often answered by pharmacy technicians
– or by pre-registration pharmacy technicians/pharmacists
• very similar to hatch/bedside but at patient’s leisure
• patients encouraged to read PIL and call back if needed
Providing information to patients
Case Studies in groups:
• Complementary medicines
• Interactions
• Adverse reactions
• A Mystery
Ethical Dilemmas with information and advice
Case Studies in groups:
• Husband’s prescription
• Daughter’s medicine
• Travel medicine
• Homeopathy
Feedback
Thank you for your time.
Did the session meet the aims and objectives?
I would be grateful of any feedback so I can improve my practice if you want it to be anonymous, the conference organisers can arrange this.
Helen.Taylor@leedsth.nhs.uk
