Responding to medicines related questions in practice
Pharmacists will need to respond to requests for information on medicines from colleagues and patients.
CPPE, NES and WCPPE, together with UKMI, have produced learning programmes to support pharmacists responding to medicines-related questions.
Identifying and responding to adverse drug reactions
The Medicines and Healthcare Products Regulatory Agency (MHRA) has produced guidance on adverse drugs reactions, which includes a classification of adverse drug reactions. Pharmacists play a significant role in the identification and reporting of adverse drug reactions and as a result can help prevent hospital admissions caused by adverse events.
The RPS has produced Professional standards for the reporting, learning, sharing, taking action and review of incidents
NHS Digital (formerly known as HSCIC) has produced information on how access to summary care records can help reduce adverse reactions.
Welsh Medicines Resource Centre has published a bulletin on medicines-related admissions. The bulletin states that medicines-related admissions could be caused by the following ways:
- Unwanted side-effects
- Errors or incidents
- Poor adherence
Yellow Card Centre Scotland and NHS Education for Scotland have developed a learning resource about adverse drug reactions, including "their incidence and public health implications". It explains the different classifications of ADRs and drug allergies, how to identify if a patient is experiencing an ADR and subsequent management.”
Medicines reconciliation on admission
NICE describes medicines reconciliation as accurately listing the all of a person’s medicines including prescribed, over-the-counter, and complementary medicines. Pharmacists working in emergency departments can help recognise admissions that have been caused by issues relating to medicines.
You might find our Medication history quick reference guide helpful when conducting a medicines reconciliation. Download our medicines reconciliation checklist.
Medicines Use and Safety Team Specialist Pharmacy Service has produced Medicines Reconciliation: Best Practice Resource and Toolkit.
Medicines Use and Safety Team Results of a Collaborative Audit of Pharmacy-led Medicines Reconciliation (MR) in 56 trusts across E & SE England.
NHS Education Yorkshire and the Humber Pharmacy Development Unit have produced a document to assist in the training and development in Medicines History Taking.
Pharmacists working in urgent and emergency care settings may be involved in taking a patient medical history. This is an important opportunity to gather vital information about the patient and their presenting complaint.
Medicine discharge optimisation
NICE has produced guidelines on Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes
NICE guidelines describe medicines optimisation as “the safe and effective use of medicines to enable the best possible outcomes.
We have created a wide range of resources on medicines optimisation; including good practice guidance, a patient leaflet, and briefings on optimising medicines for a number of conditions.
NICE has also developed a medicines optimisation pathway, covering the decision making processes used to help optimise a person’s medicines; including medicines reconciliation and medication review.
NHS England has developed a Medicines Optimisation Dashboard England, which is designed to further understanding of how patients are being supported with medicines use locally. NHS England has stated that: “Reducing unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work.” You can find more information on the Right Care programme here. Tools and products to optimise the use of medicines can be found on the NHS England website, these have been brought together by NHS RightCare and partner organisations, including NICE and CQC.
CPPE has produced the following e-learning programmes relating to medicine optimisation:
Pharmaceutical Care (Scotland)
NHS Education for Scotland has produced a learning resource for the pharmaceutical care of people with dementia.
The Scottish Neonatal and Paediatric Pharmacists Group, in conjunction with NHS Education for Scotland have produced a distance learning pack on An Introduction to Paediatric Pharmaceutical Care.
NHS Education for Scotland has produced a learning resource for the pharmaceutical care of the eye.
Pharmaceutical Care and Prudent Pharmacy Wales
Your Care, Your Medicines: Pharmacy at the heart of patient-centred care presents a vision for pharmacy in Wales.
Further information on the prudent agenda can be found at www.prudenthealthcare.org.uk.
Pharmacists working in emergency departments can support with the safe use of medicines through:
- Preventing omitted doses
- Ensuring doses are administered correctly
- Engaging with GP/Community Pharmacy/Care Homes
Pharmacists have a role in supporting the reduction of inappropriate polypharmacy.
PrescQIPP has produced a Polppharmacy & Deprescribing Webkit which includes a range of information and resources.
The Scottish Government has created polypharmacy guidance for the safe and effective use of multiple medicines to manage long term conditions.
SIGN Polypharmacy guidance.
The King’s Fund published a report on medicines optimisation and polypharmacy. Exploring systems for managing polypharmacy and offering recommendations for improving care for older people and those who have two or more chronic medical conditions.
CPPE has produced a learning programme to help develop your knowledge and skills in working with patients and other health and social care professionals to enable patients to get the best possible outcomes when they are taking multiple medicines.
WCPPE has produced a learning programme to help pharmacy professionals understand the physiological changes that occur in the elderly and the impact of polypharmacy and reducing medicines wastage.
All Wales Medicines Strategy Group has produced Polypharmacy Guidance for Prescribing.
NHS Wales has developed guidance on Polypharmacy: Guidance for Prescribing in Frail Adults.
Preparing and implementing pharmaceutical care plans
Pharmacists may work with patients to help identify individual pharmaceutical care needs and develop a care plan to support this.
The Your Care, Your Medicines Report describes how pharmacists can support with pre-screening and unscheduled care through the development of a pharmaceutical care plan. You can find more information about this in the report.
Poor medicines adherence can lead to hospital admissions and difficulty in managing conditions.
Further information can be found in the RPS quick reference guide Medicines Adherence and NICE clinical guidelines on Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence.
Pharmacists have an important public health role to play in educating people about antibiotic resistance.
We have worked with University College London to create an online resource, www.AMSportal.org, which signposts to resources and information to promote learning about microbiology and antimicrobial stewardship.
RCGP is offering a free e-learning course about antibiotic resistance for all primary care health professionals in the UK.
The TARGET (Treat Antibiotics Responsibly, Guidance, Education, Tools Antibiotics Toolkit) aims to help influence prescribers’ and patients’ personal attitudes, social norms and perceived barriers to optimal antibiotic prescribing. It includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use, helping to fulfil CPD and revalidation requirements. Using the resources in the TARGET Antibiotics Toolkit will enable organisations to demonstrate compliance with the Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance. The Toolkit also supports recommendations made in the recent NICE guideline: Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use (August 2015) and is linked within the guideline.
NICE guideline [NG15] Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use (August 2015) covers the effective use of antimicrobials (including antibiotics) in children, young people and adults. It aims to change prescribing practice to help slow the emergence of antimicrobial resistance and ensure that antimicrobials remain an effective treatment for infection.
Scottish Antimicrobial Prescribing Group: Antibiotics – an information leaflet for staff in care homes and community hospitals
CPPE has produced an e-learning programme on Antimicrobials and infection management and a reducing antimicrobial resistance.
Therapeutic drug monitoring
Pharmacists may be involved in therapeutic drug monitoring and also advising others involved in this.
The BNF contains information around drug monitoring.
"The Monitoring section specifies any special monitoring requirements, including information on monitoring the plasma concentration of drugs with a narrow therapeutic index (e.g. theophylline, p. 238). Monitoring may, in certain cases, be affected by the impact of a drug on laboratory tests (e.g. hydroxocobalamin, p. 837), and this information is included in Effects on laboratory tests."
In some cases, when a drug is withdrawn, further monitoring or precautions may be advised (e.g. clonidine, p. 137): these are covered under Treatment cessation.”
(How to use BNF, BNF 72)
There are often local guidelines for therapeutic drug monitoring which you can refer to, we have highlighted an example below. London and South East Medicine Information Service, South West Medicine Information Service and Croydon Clinical Commissioning Group has produced suggestions for Drug Monitoring in Adults in Primary Care.
High risk medicines
High risk medicines can often be the cause of admission to urgent and emergency care settings. Pharmacists can support with the safe use of high risk medicines and help prevent admissions as a result of their use. When patients are admitted to urgent and emergency care settings, pharmacists may identify high risk medicines when conducting medicines reconciliation, and make appropriate recommendations.
Scottish Patient Safety Programme in Primary Care aim to reduce events which could cause avoidable harm from healthcare delivered in any primary care setting and has developed a number of tools and resources to support this. The Safer Medicines workstream focuses on the prescribing and monitoring of high risk medicines.
Falls due to medicines
Standard 6 of the National Service Framework for Older People is falls. Falls are a common cause of emergency department attendance and medicines can be a common cause of falls. Pharmacists can support with the prevention of falls.
CKS website contains guidance on sssessing risk of falling and managing people at high risk of falls.
NHS Doncaster – Community pharmacy falls prevention service. You can find further detail of this on the PSNC website .
The British Geriatrics Society has produced Fit for Frailty guidance on the recognition and management of older patients with frailty in community and outpatient settings.
All Wales Medicines Strategy Group has produced polypharmacy guidance for prescribing, this contains key considerations for prescribing in frail adults.
NICE has produced guidance on Falls in older people: Assessing risk and prevention.