Congratulations on winning the innovation, quality and efficiency category at the Scottish Pharmacy awards 2016. How does it feel to be recognised in this way?
The award is shared with my colleague Nicole Tolley who is the other pharmacist in the Glasgow Community Respiratory Team. We were very surprised to win, as there were four other excellent submissions in our category.
Nonetheless, we were delighted that our work has been recognised. The Glasgow Community Respiratory Team is funded by Integrated Care Funding from Glasgow City Council as a project until March 2018. Any recognition of our service is fantastic and promotes the great work that the whole team does supporting patients with severe chronic obstructive pulmonary disease (COPD) in their own homes.
What elements of your respiratory practice did the judges particularly like?
We have not had specific feedback, however our service contains many of elements that are in the Prescription for Excellence:
- We visit patients to provide pharmaceutical care in a domiciliary setting.
- Our team is multidisciplinary (consisting of physiotherapists, occupational therapists, respiratory nurses, dietitian, healthcare support workers, administration and pharmacists). In order to optimise the care of our patients, each member of the team refers as appropriate to the different disciplines to ensure that the most appropriate and holistic care is delivered. We also work closely with hospital respiratory nurse specialists, respiratory consultants and GPs.
- We have a patient-centred approach that involves a partnership between the patient and the clinician. We encourage patients to give their own feedback on their medication and encourage them to becomes actively involved in their pharmaceutical care
- As a service, we undertake collaborative goal setting ensuring a patient-centred approach to care.
- We liaise with our GP colleagues to reduce harmful and wasteful prescribing.
- We also liaise with our community pharmacy colleagues to support patient compliance and minimise waste.
- We have collaborative partnerships with our social care partners and signpost patients into social care services as appropriate.
As a respiratory pharmacist, what is your top tip especially for community pharmacists?
Just one? There are so many ways community pharmacist can support patients with asthma and COPD. (This list is not exhaustive!)
- A really important aspect is to identify salbutamol overuse (more than one per month for an asthma patient). This is an indicator of poor control, and appropriate measures should be taken to improve asthma control. The British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) Asthma Guidelines 2016, suggests such patients should have an urgent asthma review. So, speak to your patients and encourage them to attend for an asthma review.
- Counselling on inhaler technique – it is a challenge with so many devices on the market, but very worthwhile as community pharmacists may well be the healthcare professional that patients see most frequently. It would be worth liaising with your GP practice to identify patients who could benefit from this service.
- Be able to recognise the danger symptoms of an asthma attack and get urgent help as required.
- Be able to recognise a COPD exacerbation and refer as appropriate.
- Try to avoid waste – some pharmacies order inhalers and/or nebules every month for their patients who have dosette boxes. I remove hundreds of pounds of excess inhalers and nebules from patients’ homes which have been stockpiled. A simple phone call to check whether the patient requires the inhaler, and if they are having any issues, can identify poor compliance or difficulties in using the device prompting referral to the appropriate healthcare professional (HCP) for support.
What tools or devices do you use to assess inhaler technique?
Patients who use our service have frequent exacerbations, so we use disposable training devices to minimise spread of infection. We use placebos and training devices such as whistles, so that we can assess the patient using the device.
Our COPD patients are usually severe and can have poor inspiratory flow rates, so not all devices are suitable. Also, we want the patient to feel comfortable with the device, so having a few placebos can help this as the patient can choose. Where there are compliance issues or cognitive problems the once daily devices are really helpful.
How can community pharmacists work more closely with, and benefit from the expertise of pharmacists like yourself?
Any HCP, including community pharmacists, in the areas we cover in Glasgow can refer patients into our service. We can give advice over the phone about the referral process and suitability of the patient to our service. We also have leaflets advising the services we provide. If a pharmacist has an interest in providing a service for patients with COPD and has queries I will always try to help.
What’s your view on community pharmacy in Scotland?
My background is community pharmacy and I worked full-time as a community pharmacist until two years ago.
Over the 25 years that I have been qualified I have seen huge changes in the services which community pharmacists provide, and I am immensely proud of the service which we provide in Scotland. The ancillary services which are now embedded in the daily routine such as eMAS, gluten-free services, smoking cessation, out of hours services are now taken for granted by the public.
The changes which have taken place over the last 10 years are remarkable, and it is a testament to our profession that we have evolved and embraced these roles which are so important to our patients. I look forward to supporting the new initiatives which are forthcoming such as Quality Improvement and Closer Partnership Working. I also strongly support the NES Foundation Vocational Training for Community Pharmacy which would will support newly qualified pharmacists to improve their professional confidence and competence.
That notwithstanding, I am aware of the huge pressures many community pharmacists work under on a daily basis providing an excellent prescription supply service. Personally, I have always worked in smaller pharmacies where I can have as much patient contact as possible. For those busy dispensaries, it is vital that there is an appropriate workload per pharmacist and an appropriately skilled pharmacy support team (including technicians), to ensure safe and timely supply of prescriptions.
When was the last time you spent a significant amount of time in community pharmacy?
I regularly locum in a community pharmacy every week! I also work as a Pharmacy Champion for NHS Lanarkshire to support community pharmacies to implement new initiatives.
I am part-time with the Community Respiratory Team (2 days), I also work on a sessional basis with NHS Lanarkshire (1 day) carrying out polypharmacy reviews for patients in care homes. I have also carried out locums in a GP practice doing medicines reconciliation for hospital discharges and flu vaccination clinics.
Do you manage to make use of your independent prescribing qualification to the fullest extent?
I use my prescribing qualification when I carry out polypharmacy reviews in care homes and when I locum in GP practices. There are some practical difficulties in carrying out independent prescribing within the Community Respiratory Team, as we cover the whole of Glasgow and would need prescription stationery to reflect this. However, this is an area we are looking to develop in the future.
What is your next move in terms of applying the IP skills in your pharmacy?
I would hope in the future we can develop a way to prescribe for acute exacerbations in the Community Respiratory Team.
If you qualified again would you choose community pharmacy, hospital pharmacy or GP practice pharmacy?
I suspect I would choose hospital pharmacy then move into primary care, but I would want to have a role where I had direct patient contact as this is the reason I enjoy my job so much!
What are you working on at the moment?
I am working on having a regular day off! I must have completed about five years’ worth of CPD in the last two years! I have been so busy developing my role in the care homes and the Community Respiratory Team over the last two years that now I need to spend more time with my family!!
What’s your vision for pharmacy within the NHS?
I think the future for pharmacy within the NHS is bright. There is much work to be done in Scotland with our ageing population and increasing number of patients with multiple comorbidities. Good patient-centred pharmaceutical care is such an important issue for these patients.
There is a huge focus on multidisciplinary working and when pharmacists become involved in these teams we are proving our worth in improving patient care.
I also see the supply role of community pharmacies developing and changing with new technology and improved staff support through increased use of technicians. I hope that in the future this will enable our community pharmacists to make better use of their clinical skills to work together with their GP colleagues. There is much scope to support GPs to manage the enormous workload of patient care and deliver good quality patient-centred pharmaceutical care.
My wish is that the profession continues to engage with our fellow health and social care partners to promote and demonstrate the added worth that pharmacists can provide in the holistic management of patients.