1. Pharmacists training program Provide support materials
Redesign of emergency contraceptive services in the community pharmacy.
Noel Wicks BPharm (Hons)
Right Medicine Pharmacy Ltd
79-81 Bandeath Industrial Estate Throsk, Stirling, FK7 7NP
Aim
The aim of the project was to redesign the EHC service delivered through Right Medicine Pharmacy branches in order to create a better consultation service within the pharmacy as well as incorporate Ulipristal which had been recently added as an alternative choice to Levonorgesterel.
Plan
We identified a number of key areas that we wanted to change and subsequently evaluate after 3 months. These included;
Pharmacist education – Pharmacists were unsure of the role of Ulipristal and it’s difference from other forms of EHC.
Supporting paperwork – The current EHC service paperwork were pharmacist led and were largely closed type questions. This meant an “interrogation” type consultation process rather than a two-way consultation or conversation with the patient.
Questionnaire – One for patients to complete after accessing the service and one for Pharmacists at the end of the study. Do
As well as requiring the updated NES module on EHC to be completed we provided face to face training on EHC, Ulipristal and the newly designed paperwork.
We also ran training on risk based prescribing to facilitate appropriate product choice.
Pharmacists training program
This allowed patients and/or pharmacy staff to complete key background info as well as providing the pharmacist with an aide memoire covering prescribing choices and an area to record required supply information such as batch number.
Redesigned forms
Including Contra-indications/interactions sheet and patient take away counselling points for EHC.
Provide support materials
Study
PATIENTS
We recorded a high degree of patient satisfaction (above 85% agree or strongly agree) in the following;
The professionalism and knowledge demonstrated by the pharmacist
Empathy of the pharmacist
Information given to allow (patient) choice of EHC
Counselling on the use of EHC
Overall satisfaction with the service.
There were lower satisfaction levels with explanations on long term contraception (30% agree or strongly agree) ) and information on STI’s and screening (60% agree or strongly agree) ).
PHARMACISTS
There were eight questions on the pharmacist survey that was completed by eighteen of our pharmacists. The percentage that agreed or strongly agreed is shown in brackets.
It's helpful that other pharmacy team members can start consultation by giving the patient the form to fill in. (77).
Patients find it easy to complete the front part of the forms (83). Patients filling in the details saves me time (83).
Patients filling in the details saves me asking awkward questions (72).
The new forms give me more time to counsel patients (88).
The new EHC forms are easier to use than the old ones (72).
I prefer having a separate sheet that has more detailed information on interactions and contra-indications (72).
It's helpful to have a counselling points reminder card to give patients to take away (94).
Act
The initial objectives of the project were achieved although there were some challenges and learnings along the way including;
Support staff need training and materials as well as the pharmacists in order to engage with the changed service.
We want to improve the advice given around longer term contraception and also STI’s. This could include the ability to book patients into local testing facilities or a sexual Health clinic. It would also be beneficial to have the ability to provide “quick start/bridging” contraception by the pharmacist immediately after a patient accesses the EHC service in the pharmacy.
It was difficult to collect data effectively in the pharmacy using a paper system. We intend to use the new NHS wifi enabled tablets to collect future study information to streamline this process.
Acknowledgements
I would like to acknowledge the help and support of colleagues in Right Medicine Pharmacy.