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Digital notification system helps pharmacists to support patients with mental illness

A digital communication system, which highlights patients who need extra support with antipsychotics and antidepressants, has been developed by Cheshire and Wirral Partnership NHS Trust and shown resounding success in pilot.

The Cheshire and Wirral Partnership NHS Foundation Trust pharmacy team

Source: Cheshire and Wirral Partnership NHS Foundation Trust

Jasmeen Islam, deputy chief pharmacist at Cheshire and Wirral Partnership NHS Foundation Trust (fourth from the left), and the rest of the Trust’s pharmacy team

Some eight out of ten community pharmacists participating in a pilot of a novel notification system said it helped them to support patients with a serious mental illness.

The system, has been running since January 2018 and, to date, patient referrals have been sent to 133 pharmacies through the system, which alerts community pharmacists when patients discharged from hospital have been prescribed a new antipsychotic or antidepressant.

The success of the scheme was revealed by Jasmeen Islam, deputy chief pharmacist at Cheshire and Wirral Partnership NHS Foundation Trust, and her team, which carried out an internal survey of 30 of the pharmacies involved.

Islam’s team set up the notification system, which uses PharmOutcomes to communicate prescription details from secondary care to the patient’s chosen community pharmacy.

The protocol has been developed to pass on relevant details about patients when there is a potential risk of adverse effects, or risks to a patient’s health or wellbeing. For example, when a patient is newly prescribed the antipsychotic medicine clozapine, the system will flag whether or not the patient is a smoker, because smoking cessation can lead to a rise in blood clozapine levels.

The system also issues reminders for pharmacists to look for possible adverse reactions. For clozapine, this could include constipation and cold-like symptoms, and the latter can occasionally indicate neutropenia, says Islam. 

To date, 322 referrals have come from the trust’s clozapine clinic. Of these, 90% or more of clinic patients who were asked said the referral scheme had been helpful to them, Islam said.

Community pharmacists can also use the protocol to send queries back to the secondary care team.

“[The system] provides an enhanced safety net around the support and advice given to patients in their community,” Islam said, adding that her team’s own analysis had revealed that using the system has prevented potential readmission to hospital in 29% of cases.

The notification system was first piloted in the Wirral over the last 18 months in 133 pharmacies and is now being expanded to parts of Cheshire. Islam said her team had been approached by several organisations to share their experience and learnings to date.

The notification scheme led to the Cheshire and Wirral Partnership NHS Foundation Trust being shortlisted for five categories in the 2019 Health Service Journal Patient Safety Awards, the ceremony of which was held in Manchester on 2 July 2019.

“The next step is to look at where we can align to the ‘NHS Long Term Plan’ and reduce some inequalities around physical and mental health,” Islam said.

Islam’s team are planning to publish their findings at a later date.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206762

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