Improving the patient experience of information on medicines

1. Improving the patient experience of information on medicines Helen Taylor, Pharmacy Technician

2. Find out some implications of current landscape and drivers Explore the type of questions people ask Think about and understand why they are asking Use some key resources Discuss some ethical dilemmas Aims of the session

3. Francis report Medicines Optimisation agenda Review of the Medicines Act We’re in a recession, darling! What’s going on

4. Public enquiry into the events at Mid-Staffordshire Trust, where institutional culture focused on business, targets and the assumption that problems were someone else’s responsibility The then Secretary of State for Health, the Rt Hon Alan Johnson MP, said: ‘I apologise on behalf of the government and the NHS for the pain and anguish caused to so many patients and their families by the appalling standards of care at Stafford hospital, and for the failures highlighted in the report’ Ripples are spreading: GPhC & patient involvement http://www.pharmacyregulation.org/gphc-council-agrees-actions-response-francis-report Mandate for Training https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/203332/29257_2900971_Delivering_Accessible.pdf APTUK Pharmacy Technician Journal– president’s article (PTJ Spring 2013; p4) The Francis Report

5. Pharmacy not specifically mentioned – does that mean all is ok? ‘Foster a common culture shared by all in the service of putting the patient first’ - looks a bit like GPhC standard 1 to me Reflect on your own attitude and behaviour Take responsibility and be accountable for your words and deeds Be prepared to challenge the judgement and actions of colleagues and other professionals if necessary Francis report continued

6. ‘Helping patients to make the most of medicines’ published by the RPS in May 2013 http://www.nhs.uk/aboutNHSChoices/professionals/healthandcareprofessionals/your-pages/Documents/rps-medicines-optimisation.pdf endorsed by NHS England, ABPI, RCN, Royal College of GPs, Acadeny of Medical Royal Colleges (makes me wonder where our badge is on the front of it – or why not??) ‘The evidence base..clearly demonstrates there is much to be done to help patients, public and society more broadly get best outcomes from medicines’ ‘From patients receiving insufficient information about their medicines to too many hospital admissions caused by ADRs which could have been prevented, professionals and patients need to work much closer together to improve the quality of medicines use’ Medicines Optimisation

7. Broad principles: Patient focussed Right patient, right choice of medicine, right time Holistic approach Enhanced partnership between health care professional and patient Looks at how the patient uses their medicines over time: Prescribing does not mean taking Taking does not mean compliance Compliance does not mean always Statistics are disturbing: ‘Only 16% of patients take a new medicine as prescribed, experience no problems and receive as much information as they need’ Medicines Optimisation continued

8. Four guiding principles: Aim to understand the patient’s experience Evidence based choice of medicines Ensure medicines use is as safe as possible Make medicines optimisation part of routine practice Have a look at some of the examples for yourself – medicines optimisation doesn’t have to be difficult! Medicines Optimisation continued

9. Principle 2: evidence based choice of medicines NICE state that if a medicine has a positive appraisal, it must automatically be included on your local formulary Make your formulary work for you: A Place for Everything, and Everything in its Place Highlander Rules – In the End, there can be Only One Lean to the Extreme Web-based so accessible by community pharmacies without N3 www.leedsformulary.nhs.uk Medicines Optimisation

10. Medicines Optimisation

11. Started in late 1990’s Re-evaluted, Re-badged, Re-vamped in 2010 cards distributed with all medicines given to patients Approximately 80 calls and 1 email per month Patient Helpline at Leeds • Need information and advice about your medicines? • 0113 206 4376 • Leeds Medicines Information Service • Monday - Friday 9 am - 5pm • Saturdays, Sundays, Bank Holidays 9 am - 3 pm • medicines.information@leedsth.nhs.uk • When you contact us, we usually need to know: • The names and doses of your medicines • Your unit number ……………………………. • Any medicines or alternative remedies that you buy

12. What do you think people ask about ? Patient Helpline continued

13. some enquiries fit into more than one category does not include the non-clinical queries (signposting) Patient helpline – types of enquiries

14. Availability or supply: obtaining further medicines post-discharge unavailability of medicines in the community medicines reconciliation issues(has my diabetes been cured?) Adverse effects: potential (what’s worrying in the PIL) actual (what to do next) 4 x yellow cards submitted to the MHRA Choice of therapy/cautions/contraindications what is tablet x for? concern about items in the PIL second opinions Patient helpline: most common enquiries

15. Administration/dosage: confirmation of doses changed on admission/discharge when to start/stop a course what time of day to administer x medicine how to give tablets to a baby (!) how to administer small oral doses without a syringe Others: interactions, including with food, tobacco, illicit medicines and alcohol medicines for animals (!) non-pharmacy queries e.g. when does home-help visit/ where’s my dinner/ why haven’t my walking sticks been mended? Patient Helpline continued

16. Answering: 80% answered within an hour (often at time of call) most via telephone, some via email/letter, we can text to say answer is ready so they can call when convenient < 7% answered more than one day later (usually complex; sometimes needed to contact manufacturers) often answered by pharmacy technicians or by pre-registration pharmacy technicians/pharmacists very similar to hatch/bedside but at patient’s leisure patients encouraged to read PIL and call back if needed Patient Helpline continued

17. Case Studies in groups: Complementary medicines Interactions Adverse reactions A Mystery Providing information to patients

18. Case Studies in groups: Husband’s prescription Daughter’s medicine Travel medicine Homeopathy Ethical Dilemmas with information and advice

19. Thank you for your time. Did the session meet the aims and objectives? I would be grateful of any feedback so I can improve my practice - if you want it to be anonymous, the conference organisers can arrange this. Helen.Taylor@leedsth.nhs.uk Feedback