Pharmaceutical Care Awards
Services redesigned around complex mental health patients
Patients on high-risk medicines for mental health conditions can access physical health checks and medicines support in the community.
Source: Nadia Attura
If someone requested that you dismantle your whole mental health pharmacy service and rebuild it to allow daily clinical support for complex patients in the community, you might think that was a big ask. But this is what a Sunderland-based team, led by deputy chief pharmacist Claire Thomas, managed to achieve in just three months.
One of the Pharmaceutical Care Awards 2014 finalists established a service offering baseline physical health checks for mental health patients newly started on high-risk medicines such as clozapine, lithium or depot antipsychotics, after identifying gaps in the services that were available for those patients.
“Historically, mental health trusts have looked after [patients’] mental health and assumed GPs were looking after the physical health, while GPs have assumed that, because they are mental health patients, everything is being looked after by the mental health trust,” Thomas explained during a Q&A session at the awards. She added that specific services were provided for patients taking particular medicines, but nothing was available for the wider patient population.
There was perhaps some reticence about moving from that safe environment of working as part of a ward team to working as an independent clinician in a community setting
The project involved integrating pharmacists and pharmacy technicians into a multidisciplinary team of doctors, nurses and healthcare assistants, which initially presented something of a challenge. “There were some frank discussions about how these clinics should be run and managed,” Ms Thomas explained.
Lead clinical pharmacist Venessa Echanique told the audience that for the pharmacy team “there was perhaps some reticence about moving from that safe environment of working as part of a ward team to working as an independent clinician in a community setting”. However, the team found that pharmacists and technicians not only brought their clinical knowledge to the role, they also brought organisational skills and a sense of calm — “the kind of skills that are inherent in pharmacists and pharmacy technicians through their training”, Thomas said. The psychiatric nurses were also able to share their expertise with the pharmacy team via clinical shadowing, demonstrating how to assess someone’s mental state.
Echanique advised others attempting to establish a similar service to engage those who will be referring patients, including consultants and GPs, early in the process. She also believes the service does not necessarily have to be solely for mental health patients. “We’ve developed roles for pharmacists using the general skills they have, and we’ve used them in a specialist setting,” she explained, adding that there are many other long-term conditions where high-risk medicines are a factor.
Pharmacists and technicians attended the five-day-a-week clinic on a sessional basis, with patients making appointments for medication reviews and other services. Alternatively, patients could just drop in at their convenience, knowing that a member of the multidisciplinary team would be available to see them. “The service was really designed to be much more patient-focused,” Thomas emphasised.
At the clinic, patients were able to access a “point of care” blood analysis service, physical health checks and support to help them take their medicines correctly. Additionally, members of the pharmacy team were responsible for prescribing, taking drugs histories and giving advice on side effect prevention, monitoring and management, while pharmacy technicians led clozapine clinics. For the pharmacists, having a direct impact on patient care is a “real benefit”, Thomas remarked.
Some 997 patients visited the clinic between April 2013 and March 2014 and the pharmacy team made a total of 630 interventions, 96 of which were medicine reconciliations. When a sample of patients was surveyed, all said they had found the medication reviews with the pharmacists helpful. Clinicians who referred patients to the service also commented that “it shows how valuable pharmacy input is”.
Clinical outcomes data about the service will now be collected. This will include assessing the number of patients who have been referred appropriately based on their physical health conditions, identifying patients who have been supported with smoking cessation or weight management and evaluating any patient safety incidents. As well as seeking further feedback from the patients, the team will also be evaluating the impact of the service on the wider trust and health economy through the use of structured interviews.
About the awards
The Pharmaceutical Care Awards 2014 were held on 19 June at the Royal Institution in London. The awards are run by The Pharmaceutical Journal and the Royal Pharmaceutical Society (RPS) and are supported by GlaxoSmithKline (GSK).
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065922
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