This was a village pharmacy dispensing around 5000 NHS items per month. The NHS items included supply to patients in Monitored Dosage (MDS) trays and services to a care home. Other NHS services provided were the standard Scottish pharmacy contract services. Services provided under PGDs were unscheduled care, smoking cessation, emergency hormonal contraception and chloramphenicol ophthalmic products. The pharmacist was an independent prescriber running a fortnightly pain clinic.
- 4.1 - The pharmacy services provided are accessible to patients and the public
- 4.2 - Pharmacy services are managed and delivered safely and effectively
Why this is notable practice
There is a proactive approach to identifying patients that would benefit from the various services offered, and engagement with the local community, services and other healthcare professionals. Medicines optimisation in partnership with patients results in positive outcomes with continuing treatment and low incidence of side effects.
How the pharmacy did this
The pharmacist had access to a clinical portal of patients records which had been invaluable when counselling patients and reduced queries to prescribers. In order to maintain confidentiality and keep access limited to necessity, a log was kept of each access with the reason and outcome.
The pharmacy liaised with community groups and care services, which had improved how patients used and understood their medicines with positive outcomes. The pharmacist gave thorough counselling to all patients when collecting their medication, particularly those receiving new or high-risk medicines. The main aspect of Chronic Medication Service that was being addressed in this pharmacy was around patient care and counselling. There were reminder notes at the pharmacist checking bench to highlight all patients being prescribed pregabalin and epileptic medication for appropriate counselling. This involved identifying what medication suited them best given the indications. He documented this and checked that the pharmacy records matched the GP’s records. Patients welcomed this and it was found to be a better approach than trying to explain a new service that may later involve serial prescribing.
New medicines reviews undertaken had highlighted that a number of patients had been changed from warfarin to rivaroxaban, but with very little information. The pharmacist had obtained a patient’s guide to the various conditions it was used for from the manufacturer, together with an alert card for patients to carry, to share with other healthcare professionals and remind them when to seek additional help, and signposting them to various other sources of information. Due to the success with CMS in this pharmacy using this approach was being promoted in other branches. Literature and warning cards were also available for other anticoagulant therapy, lithium, methotrexate and steroids and these were all used as appropriate when counselling patients. The record of a patient starting on pregabalin with instructions to increase the dose daily, indicated that, on counselling, the pharmacist changed this advice to reduce the rate of increasing with a view to minimising side effects. The patient was followed up two weeks later, had followed the pharmacist advice and symptoms were improved and side effects had been avoided.
The pharmacist was an Independent prescriber, holding fortnightly pain management clinics within the local surgery. Due to restrictions on controlled drug prescribing when this was set up he worked to a care management plan that had been agreed with doctors, but there was scope for him prescribing most drugs involved in pain management including controlled drugs. There was good communication with medical prescribers and some patients were jointly managed or passed from doctor to pharmacist. The pharmacist had a full caseload of patients, having demonstrated the value of his input to medical prescribers. Pharmacist appointments were half an hour so he had longer to discuss options and concerns with patients than doctors did.
The pharmacist had attended local events and individuals, to promote targeted pharmacy services. This included minor ailments service and other pharmacy services including using an otoscope to triage patients with sore ears to the local baby and toddler group. This had led to an increase in consultations, ensuring young patients were triaged as soon as possible.
The pharmacist had recently developed a newsletter to share relevant information with medical colleagues. This covered topics such as the CMS, stock shortages and issues, the NHS smoking cessation service and other services offered.
What difference this made to patients
Services provided are aligned with patient needs, reflect the health needs of the local community and there is promotion and engagement with the local community. A proactive approach to promoting services has been adopted. Pharmacy services are managed in such a way that each patient receives thorough pharmaceutical care with extra attention given to patients on new or high-risk medication.
We have identified the standards most likely and least likely to be met in inspections, and highlighted examples of notable practice for each of these standards; to help everyone learn from others and to support continuous improvement: