Pharmacy type
Community
Pharmacy context
This was a village pharmacy serving a rural community, located close to a city dispensing around 5500 NHS items per month and a small quantity of private dispensing. The NHS items included supply to around 28 patients in Monitored Dosage System (MDS) trays. Other NHS services provided were the standard Scottish pharmacy contract services – Chronic Medication Service (CMS), Minor Ailments Service, smoking cessation and the gluten free food prescribing service. Services provided under PGDs were unscheduled care, smoking cessation, emergency hormonal contraception, chloramphenicol ophthalmic products and post-immunisation. A substance misuse service was provided to buprenorphine patients. There was a consultation room.
Relevant standards
- 4.1 - The pharmacy services provided are accessible to patients and the public
Why this is notable practice
The pharmacy team has a good level of awareness of the difficulties that some elderly patients face in accessing pharmacy services and other health services and it makes appropriate adjustments to meet the access needs of such patients.
How the pharmacy did this
The pharmacy had a large number of elderly patients suffering from dementia and other conditions related to age and services had been developed to meet their specific needs. All pharmacy staff members were ‘dementia friends’ to improve their understanding of this.
One of the dispensers had experience of ‘sighted guiding’ and was involved with guide dog training at a very early stage. This gave her insight into partially sighted patients and their needs which she shared with colleagues. Several guide dogs in training and pre-training were homed locally and they were welcomed into the pharmacy.
Occasionally staff members signed prescriptions for partially-sighted patients, but more often encouraged them to sign themselves and staff ticked the appropriate boxes. There was good awareness of giving patients the opportunity to be as independent as they could.
The consultation room was used by all members of staff with patients who were hard of hearing, to maintain confidentiality and protect their dignity while ensuring they understood what was being said. Written notes were often used and conversations were held face-to-face to allow them to lip-read.
Strategies used to help patients with visual impairment included writing reducing doses in tabular form and use of large print labels.
The pharmacy provided additional support to patients who were confused with medicines out of alignment and having to get several prescriptions a month. There was a process in place that allowed the pharmacy to realign medicines and request prescriptions for unusual quantities to bring all medicines into line to streamline the process for patient, prescriber and pharmacy. One patient suffering from dementia had a routine of coming to the pharmacy on a particular day each week and required some of her medicines each week – these were not being brought into alignment as it was recognised that this weekly routine worked for this patient and the pharmacy staff closely monitored her compliance to ensure that her needs were met. There was a note to this effect on her record to ensure that locum/relief pharmacists did not try to bring her medicines into alignment.
When patients were observed to be having difficulty with medication the pharmacist or staff member sat down with them in the consultation room to discuss their needs and issues and they had a ‘dummy’ MDS tray made up for demonstration purposes. One patient with arthritis had struggled to remove tablets from the packaging and so a dispenser had demonstrated how to use the tray, allowing the patient to practice using it and this patient is fully compliant.
Services provided were displayed within the pharmacy and externally. Signposting to other services was described including travel services, ophthalmic and audiology services. Appointments could be made for patients for these services as appropriate.
What difference this made to patients
The pharmacy team routinely makes adjustments to the way in which pharmacy services are provided, to make them more accessible to individual patients. It also books appointments for patients with other health services where they are may have difficulty doing this themselves.
Highlighted standards
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: