Improving remote prescribing in a CAMHS community team during the COVID-19 pandemic

AimsPrior to the COVID-19 pandemic, prescriptions were usually collected by patients/families in person from the CAMHS community team base. Due to social distancing measures introduced during the pandemic, face-to-face contact between staff and patients had to be minimised. This led to an increase in remote prescribing, including from home. Feedback from team doctors was that the process of following the Remote Prescribing Protocol (RPP) was taking up a significant portion of their day, preventing them from doing other clinical work.Our aim was to reduce the time taken to complete a remote prescription to pre-pandemic levels (under 15 minutes).MethodWe used PDSA methodology in this QI project: 1)Plan: Survey sent out to team duty doctors to identify the most time-consuming steps in RPP which could be safely delegated to administrative staff2)Do: Email sent requesting administrative staff clarify several details with patients/families when they request a prescription. This included the names and doses of medication, how many days they had left, where they wanted the prescription sent to (home/pharmacy) and the relevant address. If the patient usually received their repeat prescription from their GP, they were re-directed to their GP3)Study: Following the intervention above, team doctors recorded how long it took to complete a remote prescriptionResultThe average time taken to complete a prescription fell from 31 minutes (pre-intervention) to 22 minutes (post-intervention). The range of time taken also dropped from 10-241 minutes (pre-intervention) to 0-46 minutes (post-intervention). The medications taking above the average time to complete were more likely to be non-controlled drugs rather than controlled drugs (which one may typically think would be more time-consuming to write out).ConclusionWhilst we have successfully reduced the time for remote prescribing, we have not reached the target of reducing it down to less than 15 minutes (pre-pandemic timings). As part of the next PDSA cycle, we have carried out a survey to ask what barriers remain. Checking patient's notes and recent prescriptions can still be inefficient. We propose introducing an intervention whereby this can also be safety delegated to administrative staff e.g. including a copy of the most recent prescription in the request.In the future, we will continue to improve the RPP with further PDSA cycles and carry out an audit on the system on a regular basis to ensure standards are met.

Pharmacy Technology to Better Public Health

Healthcare access and delivery faces significant global and local challenges. This article aimed to explore the public's use of pharmacy services and aimed to obtain 200 completed surveys across eight districts of Bristol, UK, from non-registered pharmacy premises. Respondents reported as follows: 1) ability to order a repeat prescription (79.47%), 2) ability to collect a repeat prescription (72.63%), 3) ability to collect an acute prescription (66.84%), ability to purchase over the counter (OTC) medicines (59.79%), 4) followed by asking for specific advice on prescription medicines (48.42%), and 5) minor ailments (44.15%). Respondents had used the pharmacy at least once for collecting a repeat prescription for a routine medication (59.47%) or acute prescription (55.79%) and for buying OTC medicines (47.89%). Majority of respondents never approached a community pharmacist to specifically ask advice on medicines (51.32%). Participants had not ever approached a community pharmacist for minor ailment/health advice (71.58%).

Determinants of intentions to monitor antihypertensive medication adherence in Irish community pharmacy: a factorial survey

Background Community pharmacy represents an important setting to identify patients who may benefit from an adherence intervention, however it remains unclear whether it would be feasible to monitor antihypertensive adherence within the workflow of community pharmacy. The aim of this study was to identify facilitators and barriers to monitoring antihypertensive medication adherence of older adults at the point of repeat dispensing. Methods We undertook a factorial survey of Irish community pharmacists, guided by a conceptual model adapted from the Theory of Planned Behaviour (TPB). Respondents completed four sections, 1) five factorial vignettes (clinical scenario of repeat dispensing), 2) a medication monitoring attitude measure, 3) subjective norms and self-efficacy questions, and 4) demographic and workplace questions. Barriers and facilitators to adherence monitoring behaviour were identified in factorial vignette analysis using multivariate multilevel linear modelling, testing the effect of both contextual factors embedded within the vignettes (section 1), and respondent-level factors (sections 2–4) on likelihood to perform three adherence monitoring behaviours in response to the vignettes. Results Survey invites (n = 1543) were sent via email and 258 completed online survey responses were received; two-thirds of respondents were women, and one-third were qualified pharmacists for at least 15 years. In factorial vignette analysis, pharmacists were more inclined to monitor antihypertensive medication adherence by examining refill-patterns from pharmacy records than asking patients questions about their adherence or medication beliefs. Pharmacists with more positive attitudes towards medication monitoring and normative beliefs that other pharmacists monitored adherence, were more likely to monitor adherence. Contextual factors also influenced pharmacists’ likelihood to perform the three adherence monitoring behaviours, including time-pressures and the number of days late the patient collected their repeat prescription. Pharmacists’ normative beliefs and the number of days late the patient collected their repeat prescription had the largest quantitative influence on responses. Conclusions This survey identified that positive pharmacist attitudes and normative beliefs can facilitate adherence monitoring within the current workflow; however contextual time-barriers may prevent adherence monitoring. Future research should consider these findings when designing a pharmacist-led adherence intervention to be integrated within current pharmacy workflow.

Pharmacy Technology to Better Public Health

Healthcare access and delivery faces significant global and local challenges. This article aimed to explore the public's use of pharmacy services and aimed to obtain 200 completed surveys across eight districts of Bristol, UK, from non-registered pharmacy premises. Respondents reported as follows: 1) ability to order a repeat prescription (79.47%), 2) ability to collect a repeat prescription (72.63%), 3) ability to collect an acute prescription (66.84%), ability to purchase over the counter (OTC) medicines (59.79%), 4) followed by asking for specific advice on prescription medicines (48.42%), and 5) minor ailments (44.15%). Respondents had used the pharmacy at least once for collecting a repeat prescription for a routine medication (59.47%) or acute prescription (55.79%) and for buying OTC medicines (47.89%). Majority of respondents never approached a community pharmacist to specifically ask advice on medicines (51.32%). Participants had not ever approached a community pharmacist for minor ailment/health advice (71.58%).

P14 Discord between patients’ general practitioner repeat prescriptions and the medication list held by a paediatric cf centre

AimTo audit GP repeat prescription records in comparison with medication lists held in patients’ electronic notes (EMIS) in our centre, to identify any discrepancies and pharmacist interventions.MethodBetween October 2011 and June 2014, a pharmacist retrospectively reviewed the CF Centre medication lists, and compared them with the patient’s GP repeat prescription (accessed using Summary Care Record), identifying differences in doses, formulation, and directions. In addition, omissions from each list, drug-class duplications, drugs requiring cessation, and dosing errors were noted.The last date of dispensing was used as an indicator of adherence, and where necessary, GPs were contacted for further information.Pharmacist interventions requiring further action were recorded.ResultsDrugs (n=2009), were reviewed from 232 patient episodes. Total number of pharmacist interventions was 589 (29.3% drugs), with 20 prescribing errors identified as being clinically significant requiring immediate resolution. Dose and formulation discrepancies were noted in 141 (7.0%) and 48 (2.4%) drugs respectively. Omissions occurred on the GP prescription for 73 medications (3.6%), 30 of which were unlicensed. There were 69 (3.4%) omissions on the CF Unit medication list. Common drugs missed off the GP prescriptions were unlicensed medicines (ULM), accounting for 40% of GP omissions. Common drugs missed off the CF Centre drug list were dietary products and ‘acute’ courses (e.g. antifungals, eradication regimens) initiated by the CF Centre. The CF Centre was unaware of some GP prescribing of contraceptives and inhalers.25 patients were identified as having adherence issues.Only 35/232 (15%) prescriptions matched identically.ConclusionsThis audit identified the need for a more thorough medicine review and reconciliation in the clinic, which should at least include the GP repeat prescription. The audit identified areas of discrepancy between the CF Centre list and the GP prescription, that were previously unknown and had not been considered. It is essential that teams are aware of additional prescribing by GPs and the medication list at the CF Centre should be updated at each clinic visit. Communication regarding drug therapy needs to be improved between the CF Centre and GPs.A comprehensive medication review should to be completed before altering any drug/doses in response to poor clinical response, as it cannot be assumed that patients have access to, or are taking, medicines as perceived by the CF Team. A pharmacist in a CF clinic would be ideally placed to complete this.

Trends and risk factors for prolonged opioid use after unicompartmental knee arthroplasty

Aims The purpose of this study was to evaluate trends in opioid use after unicompartmental knee arthroplasty (UKA), to identify predictors of prolonged use and to compare the rates of opioid use after UKA, total knee arthroplasty (TKA) and total hip arthroplasty (THA). Materials and Methods We identified 4205 patients who had undergone UKA between 2007 and 2015 from the Humana Inc. administrative claims database. Post-operative opioid use for one year post-operatively was assessed using the rates of monthly repeat prescription. These were then compared between patients with and without a specific variable of interest and with those of patients who had undergone TKA and THA. Results A total of 4205 UKA patients were analysed. Of these, 1362 patients (32.4%) were users of opioids. Pre-operative opioid use was the strongest predictor of prolonged opioid use after UKA. Opioid users were 1.4 (81.6% versus 57.7%), 3.7 (49.5% versus 13.3%) and 5.5 (35.8% versus 6.5%) times more likely to be taking opioids at one, two and three months post-operatively, respectively (p < 0.05 for all). Younger age and specific comorbidities such as anxiety/depression, smoking, back pain and substance abuse were found to significantly increase the rate of repeat prescription for opioids after UKA. Overall, UKA patients required significantly less opioid prescriptions than patients who had undergone THA and TKA. Conclusion One-third of patients who undergo UKA are given opioids in the three months pre-operatively. Pre-operative opioid use is the best predictor of increased repeat prescriptions after UKA. However, other intrinsic patient characteristics are also predictive. Cite this article: Bone Joint J 2018;100-B(1 Supple A):62–7.