Views of patients and professionals about electronic multicompartment medication devices:A qualitative study

Objectives To explore the perceived acceptability, advantages and disadvantages of electronic multicompartment medication devices. Design Qualitative study using 8 focus groups and 10 individual semistructured interviews. Recordings were transcribed and analysed thematically. Strategies were employed to ensure the findings were credible and trustworthy. Participants and setting Community pharmacists (n=11), general practitioners (n=9), community nurses (n=12) and social care managers (n=8) were recruited from the National Health Service (NHS) and local authority services. Patients (n=15) who were current conventional or electronic multicompartment medication device users or had medication adherence problems were recruited from community pharmacies. 3 informal carers participated. Results Electronic multicompartment medication devices which prompt the patient to take medication may be beneficial for selected individuals, particularly those with cognitive impairment, but who are not seriously impaired, provided they have a good level of dexterity. They may also assist individuals where it is important that medication is taken at fixed time intervals. These are likely to be people who are being supported to live alone. No single device suited everybody; smaller/lighter devices were preferred but their usefulness was limited by the small number/size of storage compartments. Removing medications was often challenging. Transportability was an important factor for patients and carers. A carer's alert if medication is not taken was problematic with multiple barriers to implementation and no consensus as to who should receive the alert. There was a lack of enthusiasm among professionals, particularly among pharmacists, due to concerns about responsibility and funding for devices as well as ensuring devices met regulatory standards for storage and labelling. Conclusions This study provides indicators of which patients might benefit from an electronic multicompartment medication device as well as the kinds of features to consider when matching a patient with a device. It also highlights other considerations for successful implementation including issues of responsibility, regulation and funding

Development of a paediatric triage tool for use by pharmacists to aid clinical prioritisation of patients and delivery of pharmaceutical care

Aim To gain consensus from an expert paediatric and neonatal clinical pharmacist panel on criteria to be applied in the design of a triage tool for use in paediatric and neonatal settings. Methods The ‘Delphi Technique’1 was used to identify pharmaceutical care issues, known as criteria, to aid in the prioritisation and targeting of pharmacists’ time to deliver pharmaceutical care to paediatric and neonatal patients. Criteria based ’statements’ based upon the literature2–4 were developed and put into a questionnaire format which was distributed amongst members of the Scottish Neonatal and Paediatric Pharmacy Group (SNAPP). A five point Likert-scale and option for free hand text was used to record responses. Responses were analysed and used to modify subsequent rounds of the Delphi technique. Results 18 criteria were identified for use in the triage tool and were largely characterised upon time of review. Criteria pertaining to daily review included patients prescribed high risk medicines, psychotropic medication, continuous infusions and those with severe, acute kidney injury. Criteria pertaining to 48-hourly review included patients with stable chronic renal failure and mild kidney injury. Criteria for 72-hourly review included stable patients with no acute issues. Conclusion A triage tool to aid pharmaceutical prioritisation in paediatric and neonatal patients has been developed and will be piloted for use in clinical practice

Sustainable Implementation of Polypharmacy reviews as part of integrated care at Scale

Medication is the most common form of intervention to prevent disease or slow disease progression, with guidelines for single diseases recommending evidence based drug treatments. There remains the mismatch between prescribing guidelines for specific medical conditions and the range of clinical complexity found in individual adults with multiple morbidities. The resulting polypharmacy (use of multiple medicines) can be both appropriate and inappropriate and the key healthcare aim for individual patients is to ensure the on-going safe and effective use of their multiple medicines.NHS Scotland developed, designed and implemented national policy to consider the patient pathway and the flow of work needed to be undertaken in clinical practice to address appropriate management of Polypharmacy. Implementation across all 14 health boards serving a population of 5.5 million people in Scotland utilised Kotter’s 8 steps[1] for implementation of change supported by clinical and policy leadership, economic data and clinical outcome data. NHS Scotland have provided leadership for a European work plan. SIMPATHY , Stimulating Innovation in Managment of Polypharmacy and Adherence in the Elderly, (www.simpathy.eu) has benchmarked European strategies to address polypharmacy and through in-depth case studies in 10 EU countries, is developing strategies and tools to support innovation in polypharmacy and adherence management across Europe.Synthesis of the findings from application of change management tools such as Kotter, PESTEL (Political, Economic, Social,Technological, Environmental and Legal) and SWOT ( Strenghts Weaknesses, Opportunities and Threats), together with the case studies serve to inform further innovation. Comparison was made to other EU countries, that had started to implement a programme..Work undertaken in the Scottish programme has been used to develop an economic tool that may be used by other countries to explore the economic benefits of a national polypharmacy management programme. Transferability of innovation will be supported through publication of a reference book based on the findings of SIMPATHY.Synthesis of findings confirmed that key principles of Kotter influenced the successful implementation of national policy for management of polypharmacy in Scotland. It was identified that policy and clinical leadership were essential drivers along with a policy change that supported implementation in the service together with contractual arrangements . Lessons learned from national policy implementation in Scotland and from local programmes in other EU countries, including facilitators and barriers, together with key features of an economic tool will inform innovation of integrated care at a policy level

Polypharmacy management by 2030: A patient safety challenge

The SIMPATHY (Stimulating Innovation Management of Polypharmacy and Adherence in The Elderly) consortium have explored how healthcare management programmes can be implemented to improve medication safety and prevent patient harm by addressing the appropriate use of multiple medications (polypharmacy). Fundamental to these programmes is the principle that providers work in partnership with patients to enable shared decision making regarding medication, which improves patient adherence and medicines related outcomes. This report sets out the case for prioritising working together now to address inappropriate medication use over the next decade, to ensure the quality, economic and political systems are put in place to improve medication safety for patients. There are encouraging signs of the increasing recognition of these challenges, and the timeliness of this report. In March 2017, the World Health Organisation (WHO) launched a global challenge to address medication safety, with polypharmacy as a flagship element. A special interest group will be launched by the International Foundation on Integrated Care in May 2017

A prospective pharmaceutical needs assessment of patients prescribed antimicrobial therapy on the high dependency unit of a large teaching hospital

This poster presentation looks at a prospective pharmaceutical needs assessment of patients prescribed antimicrobial therapy on the high dependency unit of a large teaching hospital

Postgraduate education in clinical pharmacy in Europe

Different countries are at different stages of evolution in the practice and education of clinical pharmacy

Pharmaceutical care in outpatients receiving Sunitinib

This paper looks at pharmaceutical care in outpatients receiving Sunitini

Peptic ulcer disease

Section 3 of the book looks at therapeutics of gastrointestinal disorders. This chapter explores peptic ulcer diseas

Development of clinical pharmacy education in UK

Clinical Pharmacy became established in the UK in the early 1980s and the early pioneers formed the UK Clinical Pharmacy Association (UKCPA) in 1981. At this time, undergraduate Pharmacy degrees did not prepare graduates to practice clinical pharmacy and this led to Pharmacy NHS leaders co-operating with universities to develop postgraduate degrees in Clinical Pharmacy. Graduates from these degrees were then able to contribute to the planning and implementation of clinical pharmacy services and formulary management as recommended by government circulars in the late 1980s