PROPOSAL FOR ADULT DIRECTORATE

Clinical Pharmacist (Adult Directorate)

Aims:

To help in optimising the stay of each patient by ensuring more efficient drug use, and knowledge and allow the most efficient use of human resources.

Achieved by:

  1. Optimise drug therapy by ensuring choice of drug and dosing is based on improved decision making information.
  2. Optimise patient knowledge of their drugs and comfort with their medicines, to help improve long-term compliance motivation.
  3. To help reduce the length of patient stays and reduce re-admission rates, as a consequence of 1. and 2. above.
  4. Consolidate drug-related matters to one trained and specialist pharmacist, thus relieving work from existing nursing and medical staff, who can spend more time on more specialist nursing and medical tasks.

Main Targets

On admission:-

1. Complete drug history

- presented visually and made available before first ward round.
- by optimising therapy decision-making information, drug therapy can be started sooner, have a quicker onset of action and thus impact on length of stay. This effect is well documented and proven. Pharmacist input at a level greater than that proposed here is State Law in many States of the USA
- identification of individuals who may need extra input regarding drug use, compliance, previous adverse reactions etc.
- ensure a drug history is done and saves other staff (e.g. Doctors) time.

Individual treatment:-

1. Optimum drug treatment recommendations

- including kinetics, maximum doses, adequate doses, reduced polypharmacy protocols, proper adminisation techniques (e.g. inhalers) etc.
- including goals of therapy and measurement of them.

2. Individual pharmacakinetic calculations and interpretation

- e.g. lithium, carbamazepine, anticonvulsants etc.
- and ensuring appropriate tests are carried out to monitor therapy.

3. Pre-leave compliance investment

- individualised pre-leave self-medication trials.
- compliance strategies e.g. individualised dispensing, attitude changing, consequences of taking or not taking medication etc.

4. Discharge planning e.g. identifying drug related risk factors for default/ relapse etc. to allow better targeting of resources.

5. Ensuring optimum drug use protocols are followed.

- e.g. acute psychiatric emergency, tryptophan, clozapine etc. which will reduce drug problems and monitor drug expenditure.
- includes education.

6. Hypnotic use monitored and use on discharge minimised.

7. Re-use of patients own medication where appropriate.

Ward based activity:-

1. In-patient drug/medication group sessions.

- weekly, about 45 minutes on each ward.
- helps reduce conflicts and misinformation about medication.
- fosters a more positive attitude to medicines

2. Weekly or bi-weekly "drop-in" clinics for individual information on the ward.

3. Ward round participation integral as above.

4. Possible out-patient support groups, relative support group etc.

5. All patients counselled about new drugs when prescribed. - see 1. above

Pre-discharge:-

1. Discharge medication counselling (minimum half an hour - per patient).

- written information and verbal explanation - including both produces the best outcome
- pharmacy discharge letter sent to community pharmacy.
- compliance consequences as above.
- save nursing time.

2. Information on drugs sent to carer as well if appropriate.

This will ensure the availability and access to information on drugs for patients and carers (see Quality Matters new sheet).

Post-discharge:-

1. Continued Support for Community Mental Health Team (South)

- e.g. continue clinics for Breckland groups at Watton, Dereham, Costessey, Attleborough etc.
- supports the more disabled and vulnerable clients in the community.
- result of work so far indicate, user satisfaction to be at the highest level.

2. Relative support group involvement on regular basis.

- Current service to continue to supply drug information dispensing, in-service training telephone helpline etc.
In USA, such involvement has been shown to reduce stays decrease time to transfer, reduce
Polypharmacy increase doses etc.

The impact of such a post(s) would be researched and outcomes assessed.

2.96

Appendix One.

PROTOCOL FOR PHARMACIST CONSULTATIONS AND CLINICS

This protocol is followed for all pharmacist consultations occurring at clinics and similar meetings.

1.Full confidentiality will be used.

- for printing "Bespoke" leaflets, only the first name will be used.
- we do not need to know someone’s Consultant or G.P., only which Directorate they come under.

2. Advice on the drugs themselves only will be given.

- we should not discuss or give reasons why someone is likely to be taking a particular drug, nor make firm judgements about therapy, except as on the Bespoke leaflets or unless specifically asked (see below).
- an alternative is to recommend to someone that they talk to their Doctor, and maybe give them some information about how and what to say.
- beware of saying anything which could conflict with advice from GP or Consultant and hence endanger relationships.
- provide only information on the drugs themselves.
- general advice on drugs could include:-

3. Impartiality will be maintained.

- do not offer to discuss therapy with a GP of Consultant, as we are likely to come into conflict with the two parties.
- if a medical emergency becomes apparent, where not to contact the clients GP or Consultant could endanger the patients health and where the patient themselves can not be relied upon to contact a doctor, then to contact a doctor is acceptable, provided the patient gives permission.
- in either case, this should be discussed with the person organising the clinic as they will know more about each client.
- *such as emergency would include N.M.S., serotonin syndrome, acute drug toxicity etc.

4. Record keeping.

- each client to have a feedback form.
- each consultation to be entered on QARX stating:-

Advice on X drugs, Bespoke leaflets supplied, any distinguishing features or whatever is appropriate.