Challenge
The brief was to review the benefits of a clinical pharmacist working with and supporting community teams including district nurses, social services, community matrons and other specialist community support such as Macmillan nurses and physiotherapists to develop the local future model for clinical pharmacy input.
We were tasked with the aim of improving patient safety, potentially reducing hospital admissions whilst increasing the provision of care closer to home and improving the patient experience. Our aim was to optimise patients’ medication regimes and try to identify efficiencies within the current services through drug costs, drug administration and safety interventions.
Solution
MLCSU Medicines Management and Optimisation (MMO) team decided to integrate and co-locate three MMO pharmacists with three local cluster community care teams for one day a week over a three month period. The placements were to support teams with medication reviews and professional advice regarding medication.
Our pharmacists were able to attend multidisciplinary team meetings and support reviews of individual patients. We completed medicines-related audits, reviewing high-risk drugs prescribed to patients within the community teams’ current caseloads and optimised patients’ medication. We were able to reduce the number of nursing visits required, making better use of nurse time and rationalising medication regimes to attain the best outcome for patients.
Our team was on hand to answer any medicine-related queries raised by the community teams; queries were frequently linked to injectables and medication storage issues. We also provided bespoke education sessions at the request of the community teams in the areas of antibiotics and simple pain management.
Due to our team’s established links with GP practices and the local trusts we were able to support the community care teams develop closer working relationships across the locality. By connecting to surgeries in satellite locations we could quickly access records, resolve problems and seek GP advice.
We worked with our colleagues in the local hospital to develop an EMIS template for use in GP surgeries that would enable recording of outcomes across the two teams and also support GP practices by ensuring all interventions were read coded.
Impact
We improved patient care following our reviews and interventions. A summary of the outcomes is detailed below – examples include reviews of high risk medicines such as co-prescribing DOACs and antiplatelets, reducing patients’ falls risk by stopping drugs likely to increase the risk of falls, stopping prescribing of interacting medicines, ensuring regular blood monitoring and altering doses in elderly or those with renal problems.
A number of cost improvements have also been realised by optimising patients’ medication and ensuring the use of cost-effective alternatives. A reduction in nursing visits was demonstrated by optimising drug dosing schedules and a potential reduction in hospital admissions due to GI bleeds and AKI from reviewing inappropriate drugs was suggested.
| Outcome measure | Outcome | Comment |
| Potential cost savings from drug interventions | £7,640 (pa) | |
| Number of medication reviews completed | 153 | |
| Reduction in potential hospital admissions | 19 potential hospital admissions avoided. Estimated saving £33,000 | Potential admissions due to high risk of bleeds (DOACs and antiplatelet), falls, AKI and PEG blockage Using cost of £1,739 per ACSCs admission |
| Number of nurse visits saved or timing optimised | 2 visits per day giving approximate associated cost saving = £17,520 annually
| Using figure £24 per nurse visit therefore £24 x 2 visits x 365 days = £17,520 |
| Education sessions delivered | 6 | |
| Number of queries answered | 39 | 28 hours spent |
| Number of MDT meetings attended | Total = 17 | Included meetings with COCH |
Testimonial from feedback surveys:
When asked ‘overall, how would you rate having an integrated pharmacist as part of your team?’, all responses were ‘excellent’ (over 50%), ‘very good’ (over 25%) or ‘good’.
When asked ‘How would you rate the quality of the service provided by our integrated care pharmacist?’, all responses were ‘very high quality’ (over 50%) or ‘high quality’.
Comments received include:
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