1. Pharmacy Service role in supporting informal carers Inverclyde Pharmacy Change Plan Natalie O’Gorman

2. Background The predicted change in demographics will place a significant strain on health, social care and support services. Polypharmacy in the elderly is increasingly being recognised as a major issue with over 40% of over 65 year olds now on >5 medications. Drug-drug interactions, medication errors, non compliance and adverse drug reactions are all consequences of polypharmacy. Adverse drug reactions have been implicated in 5-17% of all hospital admissions. In 2009, NICE reported that approximately 50% of all medicines prescribed for long term conditions are not taken as recommended.

3. Background Previous local work has shown that medication review supports high quality, safe, clinically effective and cost effective prescribing. Follows a previous local audit of medication reconciliation at the primary/secondary care interface showing that improving communication helps reduce discrepancies. Assisting patients with managing their medications is now a significant part of the role of an informal carer. There is a need to support informal carers by providing them with information and advice on the use and administration of medication.

4. Pharmacy Service 0.8 WTE Prescribing Support Pharmacist Medication Review as a domiciliary visit For patients over 65 years on polypharmacy/ high risk medicines to reduce avoidable medication–related issues in primary care and hospital admissions for avoidable medication-related issues 0.6 WTE Prescribing Support Technician Medicine Reconciliation. Compliance needs assessment. Face-to-face medicine concordance and medicines reconciliation reviews for recently discharged patients over 65 years and to liaise with other services to ensure changes during admission are implemented in community and to support elderly patients to manage their medicines in their own home. Based within the Prescribing Team, Port Glasgow Health Centre.

5. How does the service support informal carers? Gives carers the opportunity to ask questions about the conditions and medicines of the individual they care for. Assists carers at the point of discharge by communicating with the hospital ward, GP practice and community pharmacy to ensure correct and timely follow on prescriptions and supply. Reduces polypharmacy and improves medicines safety through medication reviews to ensure that each medication has a current and valid indication, all monitoring is up to date and where appropriate, reduce the dose or dosing frequency of the medication.

6. …. Reduces confusion and potential harm through the isolation of expired, discontinued and stockpiled medications for return to a community pharmacy. Aids compliance with medication by recommending formulation changes. The service can review all the medications in a patient with a swallowing difficulty and where possible recommend changes to a licensed soluble or liquid preparation or give guidance on what medications can be crushed and how to correctly administer them. Supplies and provides counselling for a variety of compliance aids e.g. reminder charts, dosette boxes, eye dropper aids and inhaler aids which promote independence in the patients they care for.

7. …. Links with and sign posts carers to other services e.g. community pharmacy collection and delivery services, social work, community alert alarms, sensory impairment. ?? Offer medication review to carers themselves.

8. Example Case 1 72 year old female. Lives with husband. 6 week admission (HDU). 11 changes to medications. Significant changes to antidepressant and anxiolytic medication. Discharged with one week supply of medication in a dosette box. Discharge Rx posted to GP from ward. Discharge MedicationMedication at home Metformin 500mg BD Aspirin disp. 75mg mane Atenolol 25mg mane Senna two nocte Peptac liquid 10mls QDS Atorvastatin 40mg nocte Amlodipine 5mg mane GTN spray two puffs prn Diazepam 2mg prnDiazepam 5mg TDS prn Furosemide 40mg mane Ramipril 2.5mg mane Nicorandil 10mg BD Dicycloverine 10mg TDS Co-dydramol 10/500mg Pericyazine 2.5mg

9. Case 1 contd. Husband normally fills dosette box. Husband also been unwell (admission to hospital). No copy of discharge summary at GP surgery. Copy of discharge summary taken to GP for amendments to electronic record and prescription generation. Discontinued medication removed from home. Communication with community pharmacy re new dosette box and delivery. Counselling provided on medication indications and administration. Follow up visits / phone calls to patient. PHARMACY TECHNICIAN

10. Example Case 2 83 year old male Lives with wife. PMHx – Insulin dependent diabetes, Angina, Osteoarthritis On 14 repeat prescription medications. Neuropathy in hands. Finding it difficult to access medication. Can’t drive now and has difficulty getting on and off public transport so wife walking to get medication. Dosette box arranged with local pharmacy. Medications will be delivered.

11. Summary Change Fund Pharmacy Service – medication review and medicines reconciliation to support patients and carers in managing medicines Aim to reduce avoidable medicines-related issues in primary care and avoidable medicines-related hospital admissions Challenges – to focus medication review on patients/carers who benefit most and developing referrals to new medicines reconciliation service Pharmacy Input/Presentation to Carer’s Network – in line with CHCP Carer’s strategy and innovative Pharmacy service Assessment – intervention database and working with CHCP to assess impact