management of patients with respiratory disease by ... · management.4 the nhs has recently...

East & South East England Specialist Pharmacy Services East of England, London, South Central & South East Coast

Medicines Use and Safety

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Management of patients with respiratory disease by pharmacist non-medical prescribers in non-acute settings – a self-audit

Report prepared by Mandeep Butt, Project Lead and Jane Nicholls, Medicines Use and Safety Division, NHS Specialist Pharmacy Service

Background It is estimated that the cost of asthma to the NHS is in the region of one billion pounds a year, and that around 80% of the spend is on the 20% with the severest symptoms. Although deaths from asthma have plateaued at 1000 per year, the majority (90%) of these deaths are preventable. Asthma is responsible for large numbers of A&E attendances and admissions, the majority of which are emergencies. 1, 2 The cost of COPD to the NHS is also in the region of one billion pounds a year, with COPD being the second most common cause of emergency admissions to hospital and one of the most costly inpatient conditions to be treated in the NHS.2 Furthermore, the five year survival from diagnosis is 78% in men and 72% in women with clinically mild disease, but falls to 30% and 24% respectively with severe disease, making this one of the most aggressive diseases. 3 Patients at any treatment step of the BTS asthma guidelines are at risk of an asthma attack, with the risk increasing as the treatment step increases. Poorly controlled asthma may have a considerable impact on health care costs. Appropriate targeting of preventive measures could therefore reduce overall health care costs and the growing pressures on hospital services associated with asthma management.4

The NHS has recently published an outcome strategy for COPD and Asthma with the objective of improving the respiratory health and well-being of all communities. It is recognised that common components of good long-term condition management include risk profiling, integrated care teams and self-care.1 Pharmacist prescribers who are managing patients with asthma and COPD have a key role in supporting this strategy. Introduction In 2000, the Department of Health policy objectives for the development of non-medical prescribing (NMP) were to improve patient care, choice, access and patient safety through better use of health professionals’ skills and more flexible team working across the NHS.5 Since 2006, pharmacists and nurses have been able to train to become independent prescribers and more recently (2012) prescribing of controlled drugs has been included.6, 7 Evidence has shown that the benefits of NMP include: faster access to medicines, more flexible patient orientated care, time-savings and improved service efficiency. NMP has been found to be safe, acceptable to both patients and to clinicians.8

Recent evaluations indicate that overall, nurse and pharmacist prescribing is safe and clinically appropriate.9, 10 It is becoming a well-integrated and established means of managing a patient’s condition and giving them access to medicines.9

Support had been provided for pharmacist prescribing in East and South-East England since 2003, initially through the London Prescribing Project and then by Specialist Pharmacy Service, however this has now finished. With the restructuring of the NHS and the focus on clinical commissioning, it is important that pharmacist prescribers are able to demonstrate to commissioners that they are able to optimally manage patients with long-term conditions. In addition, many of these practitioners are working in relative isolation and they must be able to audit and reflect on their own practice. This project was established to enable selected groups of pharmacist independent prescribers (PIP), including those managing respiratory disease, to develop tools to enable self-audit and peer review.


Respiratory NMP self-audit report v 1.1 Nov 15 (MB/JH)

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Aims To develop tools to support pharmacist independent prescribers to develop and review their practice. Objectives

To develop and pilot sets of clinical data that would enable pharmacist independent prescribers (PIP) to examine their practice in relation to agreed best practice.

To use these datasets to collect and analyse data in selected clinic settings. Design & Methods The evaluation had 4 phases:

1. Recruitment of PIPs 2. Design of clinical datasets 3. Collection of data 4. Use of data to review practice

Phase 1 – Recruitment of PIPs All chief pharmacists in provider trusts and PCTs in East of England, London, South Central and South East Coast were contacted to identify PIPs practising in non-acute settings, who were responsible for managing a cohort of adult patients within a defined clinical setting, i.e. taking complete responsibility for an episode of care. Respiratory was one of the four most common therapeutic areas of PIP activity identified from the responses, and PIPs treating patients with asthma or COPD were invited to participate in the project. Phase 2 – Design of respiratory clinical dataset In the absence of an existing template for collecting audit data, the project lead worked collaboratively with PIPs to agree a dataset specific to respiratory patients, which was based on existing national standards of care, e.g. NICE guidance, BTS, and QOF. It was agreed that the dataset had to be manageable within the clinic time available. The version used to collect data was agreed following a two week pilot period. They were amended again in collaboration with the practitioners during a peer review meeting in January 2012, where it was decided to include a question on whether the diagnosis was queried by the PIP. The dataset was reviewed again at the end of the data collection period in April 2012, where it was decided to include a question on gender. The final version of the dataset is attached in Appendix 1. Phase 3– Data Collection In order to comply with information governance requirements (for primary care trusts and general practices) including the maintenance of patient confidentiality, an information governance (IG) form was devised. This asked each GP practice, where the PIP held clinics to agree to the data being collected and subsequently analysed anonymously by the project lead (Appendix 2). This was not required within the secondary care setting as no patient identifiable information was being shared. Ethical approval was not required as the information was to be used for self-audit and not a part of a research project. On completion of the IG form by the practice, the PIPs collected prospective data over a 6 month period. In order to reduce selection bias it was agreed that all patients seen in each clinic session for the period of data collection would be included in the analysis. Phase 4 – Review of practice Following data collection and collation by the project lead, the pharmacist prescribers met to peer review their practice as a group. The discussion was facilitated by the project lead.



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Main Findings Overview Twelve PIPs working with respiratory patients were identified and 4 agreed to participate; their details are in Appendix 3. Three worked in primary care and one in secondary care. Table 1. Breakdown by pharmacist, diagnosis and site of clinic

Pharmacist No of COPD patients No of Asthma patients Total

1 11 1 12

2 8 17 25

3 22 34 56

4 31 44 75

Total 72 96 168

Primary Care 41 52 93

Secondary Care 31 44 75

Table 1 gives the breakdown by pharmacist, diagnosis and site of clinic. Between October 2011 to March 2012 data were collected by 4 PIPs for a total of 168 patient contacts. All pharmacists saw an individual patient only once during the data collection period, so collected data for one point in time for each patient. Of the 168 consultations, 96 were for patients with asthma and 72 with COPD. 93 patients were seen in primary care and 75 in secondary care. After review of the initial dataset in January 2012, it was decided to include a question on whether the diagnosis was queried by the PIP. Data for this question was collected for 30 patients. In these 30 patients, the diagnosis was not queried in 27 patients and no data was provided for 3 patients. Management of patients with Asthma and COPD Table 2 also outlines the data provided by the pharmacist prescribers for the agreed parameters. Table 2. Results of advice given to patients

Advice Asthma n=96

Data not provided

COPD n=72

Data not provided

Drug therapy inappropriate * and amended

39 (41%)

1 14 (19%)

3

Inhaler technique assessment undertaken+

72 (75%) 7 56 (78%) 3

Inhaler technique discussed as inhalers not available for assessment+

11 (11%) - 7 (10%) -

General adherence Issues discussed and guidance provided

64 (67%) 1 50 (69%) 1

Eligible for rescue packs 33 0 29 0

Access to rescue packs checked 29 (85%) 0 25 (86%) 0

Flu+/pneumococcal vaccination status checked

88 (92%) 0 71 (99%) 0

Referral for vaccination offered where applicable+

14/15

0 10/11

0

Smoking cessation offered where appropriate+

6/8

1 27/29

0

*according to severity of airways disease, national guidelines and patient symptomology + linked to QOF data



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Medicines Management Advice Inhaler technique was assessed and discussed with 75% of asthma patients and 78% of COPD patients. A further 11% of asthma patients and 10% of COPD patients had their inhaler technique discussed with them but had not brought their inhalers to the clinic. Of the 13 asthma patients where it had not been discussed/assessed, 3 were not on inhalers, 3 had colds and no information was provided for 7 data entries. Of the 9 COPD patients where it had not been discussed /assessed, 6 were not on inhalers and no information was provided for 3 patients. General medicines adherence issues that were deemed necessary were also discussed in 67%-69% of patients. Access to rescue packs was checked in 85-86% of eligible patients. Based on severity of airways disease and patient symptomology, the PIPs also reviewed whether the drug therapy was appropriate. In 39 (41%) of asthma patients and 14 (19%) of COPD patients, it was assessed as not appropriate and changes to therapy were agreed. Table 3 shows that for the asthma patients who had changes to therapy, a large proportion of these were either stepping up or stepping down in line with BTS guidance and QIPP (Quality, Innovation, Productivity and Prevention) standard targets (for reducing inappropriate high dose inhaled corticosteroid use).11, For the COPD patients therapy changes involved adding a new medicine or modifying the dose of an existing therapy. Table 3. How drug therapy assessed as inappropriate by PIP was changed

Asthma n= 39 COPD n= 14

Step up 14 0

Step down 10 0

Change dose 5 4

Addition of a drug 0 5

Blank 3 0

Other 7 5

Other advice The influenza/pneumococcal status were ascertained in 92% and 99% of asthma and COPD patients respectively and referral made in majority of cases where appropriate (Table 2). 6/8 asthma patients and 27/29 COPD patients identified as smokers were offered smoking cessation (Table 2). Other advice given to asthma and COPD patients during the consultation is outlined in table 4. The majority of this related to weight management; healthy eating and exercise, however PIPs were also able to deal with non-respiratory related issues, e.g. stress and skin problems.



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Table 4. Other holistic lifestyle advice given

Details for 18 asthma patients Details for 21 COPD patients

Weight management, healthy eating

6 15

Advice on managing hay fever and rhinitis

3 0

Advise on other medicines 0 3

Avoiding allergens 2 0

No information 5 2

Other – Details below

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Managing acute attacks with plenty of SABA, rescue antibiotics and steroids given at 50mg dose. BMI 46. Mother died last week, currently under stress with family disagreements. Weight loss discussed for future action and potential impact on asthma management

Was given a nebuliser and uses it once a week. Patient advised that same effect can be achieved with volumatic and MDI. Given exercise DVD

Complex home life. Stress. General advised on concurrent skin problems.

Diet discussed and sources of dietary calcium + medication review

DVT prevention for trip to South Africa

Referred to GP. Family problems. Advised that she can discuss with GP in confidence.

Stopped SSRI after few days because felt it did not help. Explained that effect can take up to 2 weeks

Vit C for colds, there is little evidence to support its use in preventing colds, but eating vitamin C fresh fruit contributes to a healthy diet. Advised to change bedding as could cause allergy.

Overall, 29/45 (64%) of patients with an MRC score ≥3 were referred for pulmonary rehabilitation as per NICE guidance12 (Table 5). A higher proportion of secondary care patients (93%) were referred than primary care patients (13%). On further enquiry by the project lead, 7 out of the 12 patients were not referred in primary care as one pharmacist had thought that smokers were not eligible. Table 5. MRC Breathlessness Score ≥3 and referral for pulmonary rehabilitation

N=49 Declined Referred for Pulmonary Rehab

Not referred Not applicable

MRC ≥3 48 (one blank)

3 29/45 (64%)

14 2

Secondary Care 31 2 27/29 (93%)

2 0

Primary Care 17 (one blank)

1 2/16 (13%)

12

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Severity of Disease

Asthma Table 6 shows that overall, where data were provided, 36% of the asthma patients were assessed as having ‘severe asthma’, i.e. at BTS step 4 or 5 asthma.11 The majority of these were seen by the PIP in secondary care; 70% compared to 6% in the primary care patients.

Table 6. BTS (British Thoracic Society) Step and ACT (Asthma Control Test) results for the

asthma patients

BTS Step n=96

1 2 3 4 5 Data not provided

12 13%

21 22%

28 29%

18 19%

16 17%

1

Secondary care n=44

1 2%

0 0%

12 27%

15 34%

16 36%

0

Primary Care n=52

11 21%

21 40%

16 31%

3 6%

0 0%

1

ACT <19 20-25 Data not provided

All patients n=96

63 66%

22 11

Secondary care n=44

38 86%

6 14%

0

Primary Care n=52

25 48%

16 31%

11 21%

The asthma control test (ACT) asks 5 questions related to a patient's asthma control over the previous 4 weeks. It is a valid method of measuring asthma control, with or without lung functioning measures such as spirometry. Scores range from 5 to 25 and higher scores indicate better control. Overall, 66% had an Asthma Control Test (ACT) of <19, indicating poorly controlled asthma13 . A higher proportion of those patients seen in secondary care patients (86%) had an ACT<19 compared to those seen in primary care (48%). COPD Table 7 indicates that overall, 27 (38%) of the COPD patients were assessed as having ‘severe or very severe’ COPD as assessed by FEV1 rating. 19 of these ‘severe or very severe’ COPD patients were seen by the pharmacist prescriber working in the secondary care clinic compared to 8 in primary care. Majority of patients seen in primary care were in the ‘moderate’ rating, whereas the majority in secondary care were in the ‘severe’ rating.

Table 7. FEV1 Rating for COPD patients

Range

<30 very severe

30-50 severe

50-80 moderate

80 mild Data not provided

FEV1 Rating n=72

NA 4

(6%) 23

(32%) 27

(38%) 10

(14%) 8

(11%)

Secondary Care n=31

4

(13%) 15

(48%) 10

(32%) 2

(6%) 0

Primary Care n=41

0 8

(20%) 17

(41%) 8

(20%) 8

(20%)



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The CAT score is a short, simple and validated assessment, which measures the impact of COPD on a patient’s life in an objective manner. Both the overall score (in the range of 0–40) and the scores for the individual items can provide useful information. A CAT score needs to be considered in the context of other information such as FEV1, exacerbation frequency, and presence of co-morbidities. Patients with more severe airways obstruction and more frequent exacerbations would be expected to have higher CAT scores than patients with milder disease.14 The GOLD guidelines for the management of COPD distinguishes patients that have a CAT score of ≥10 with those that have <10 as being more symptomatic and less symptomatic as a result of their COPD respectively.15 Table 8 indicates that overall, 71% of patients had a CAT score of ≥10, indicating more severe disease.15 A higher proportion of the patients seen in secondary care (94%) had a CAT≥10 than primary care patients (54%). Table 8 – CAT scores for COPD patients

Range Total n= 72

Secondary Care n=31

Primary Care n=41

<10 12

(17%) 2

(6%) 10

(31%)

≥10 51

(71%) 29

(94%) 22

(54%)

Blank 9

(12%) 0

9 (22%)

Acute exacerbations An exacerbation is a sustained worsening of the patient’s symptoms from their usual stable state and beyond normal day-to-day variations. It is usually acute in onset. Commonly reported symptoms include worsening breathlessness, cough, increased sputum production and change in sputum colour. The changes in these symptoms often necessitate an up titration of therapy or change in medication. Asthma Overall, 38/96 asthma patients (40%) had 2 or more exacerbations in the last 12 months (Table 9). All of these were in the secondary care patients, representing 77% (34/44) of all patients seen in the secondary care setting having had 2 or more exacerbations in the last 12 months. In the primary care patients, all but 4 had less than 2 exacerbations, with 34 (65%) having no acute exacerbations in the last 12 months.

Table 9 - Acute Exacerbations and A&E Admissions -Asthma

Number of acute exacerbations in last 12 months

Secondary Care Primary Care Total no of patients

A&E attendance/ hospitalisation in last 12

months

0 6 34 40 0

1 4 14 18 0

≥2 34 4 38 23

TOTAL 44 52 96 23



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COPD

The new GOLD guidelines delineate patients who have had ≥2 exacerbations as high risk, with those who have had <2 as low risk15 Overall, 30 COPD patients (42%) had 2 or more exacerbations in the last 12 months (Table 10). The majority of these were in the secondary care patients, 24 /31 (77%) had 2 or more exacerbations in the last 12 months. In the primary care patients, 6/41 (15%) had 2 or more exacerbations in the last 12 months, with 26 (63%) having had no acute exacerbations in the last 12 months.

Table 10 - Acute Exacerbations and A&E Admissions -COPD

Number of acute exacerbations in last 12months

Secondary Care Primary Care Total no of patients

A&E attendance/ hospitalisation in last

12months

0 3 26 29 0

1 4 9 13 4

≥2 24 6 30 18

TOTAL 31 41 72 18

Discussion The results show that PIPs were able to manage respiratory patients including those with severe disease and who are traditionally referred to hospital outpatients. The results of this self-audit indicate that PIPs are able to manage patients with asthma and COPD and support GP practices and hospital organisations with achieving quality standards, optimal care and national QOF targets.16 Furthermore, the data shows that in line with national QIPP targets, stepping down of inappropriately high inhaled corticosteroid use in asthma accounted for 26% of all interventions made in asthma patients. . They were able to provide medicines management advice and other important advice/referral for respiratory patients.

Specifically, inhaler technique was discussed or assessed (where possible) in the majority of patients. PIPs also assessed smoking, vaccination and MRC Score status, referring the majority of eligible patients for follow-up. The exception was for MRC score ≥3 and referral for pulmonary rehabilitation, where 12 patients were not referred for pulmonary rehabilitation. This was because the pharmacist had not realised that ‘smokers’ were eligible. Whilst working as part of this project, the PIP has realised this and this highlighted the importance of peer support for PIPs who often work in isolation. National guidelines 1,11 for managing COPD advise that patients at risk of having, or those who have had an exacerbation of COPD should be given self-management advice that encourages them to respond promptly to their symptoms. As part of this, they should be given rescue packs containing a course of oral antibiotics and corticosteroids to keep at home for use in the event of an exacerbation. Whilst this approach is established with a strong evidence base in asthma, evidence suggestive that this is effective in reducing hospital admissions and readmissions in COPD is inconsistent.17, 18 However, recent data supports the use of rescue packs, which showed that they reduce hospital 30 day inpatient readmissions by 12.5%19. This self-audit showed that PIPs routinely checked that patients who were eligible for rescue packs had access to them. Research demonstrates that up to 50% of patients do not take their prescribed medicines as intended.20 In this study, PIPs provided general adherence advice in 67-69% of patients, i.e. advice not specific to respiratory drugs. As experts in drug therapy, PIPs can bring value-added prescribing services to respiratory management, by ensuring that inhaler technique and general adherence issues are addressed and they are well placed to manage patients with co-morbidities. This supports the PIP’s role in being able to reduce the medication burden for patients as they are able to provide a comprehensive medication review.21



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Furthermore, it has been highlighted that PIPs are able to provide holistic advice to patients with various co-morbidities that may or may not be directly correlated to their respiratory disease (see Table 4). The majority of patients with severe asthma and COPD were seen in the secondary care outpatient setting. This would be expected as the role of primary care is to manage routine care and the more complex patients would be referred to a hospital specialist. This self-audit indicates that PIPs are capable of managing more patients with more severe disease. With the right training and support PIPs are capable of managing patients with asthma and COPD, even those at the severe stages of their long term condition. The process of developing and agreeing a self-audit tool prior to data collection allowed individual practitioners to review their practice with respect to national guidance and their peers. During the peer review meeting and based on their experience the PIPs decided to include in the tool a question about the accuracy of asthma diagnosis (if insufficient measurements were done originally). Although the PIPs felt this was a useful prompt, it was found to be unnecessary, as all original diagnoses were deemed to be correct. Patient assessment and recording of data was reported by the pharmacist prescribers to be manageable within the clinic time available. As only 4 PIPs were involved in the data collection, the generalisabilty of the results is limited. The frequency of patient attendance meant that data was only collected once for each patient and so the management of patients over time could not be assessed. Future work would be required to extend the data collection period to allow an individual patient’s management to be measured over time. At a time when it is becoming increasingly essential that patients are not only managed in a clinically effective manner in accordance with national standards, but also in a cost effective way, this study has shown that PIPs are ideally placed to support this process in complex disease areas that are costly to the NHS. PIPs are able to support the national outcomes strategy for COPD and asthma1

by providing appropriate management of those with moderate/severe COPD and asthma by supporting shared decision making regarding treatment, which minimises progression, and on-going support to enable self-management of their condition and potentially to reduce the need for unscheduled care and risk of death.

Acknowledgements

The authors would like to thank the pharmacist independent prescribers who collected the data and

enabled the successful completion of the project by their support. Particular thanks are due to

Hasanin Khachi for his assistance in the preparation of this Report.

Paper reviewed by Jane Hough and Mandeep Butt for contemporaneous content in 2015.



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References 1. An outcomes strategy for COPD and Asthma in England, DH, July 11 2. An outcomes strategy for COPD and Asthma: NHS Companion Document, May 12 3. Soriano JB, Maier WC, Egger P et al. Recent trends in physician diagnosed COPD in women

and men in the UK. Thorax. 2000; 55(9):789-794 4. Hoskins G et al, ‘Risk factors and costs associated with an asthma attack’, Thorax, 2000;

55:19–24. 5. Department of Health (2000) The NHS Plan: a plan for investment, a plan for reform. 6. Department of Health. Improving Patients’ Access to Medicines: A guide to implementing

Nurse and Pharmacist Independent Prescribing within the NHS in England. April 2006. 7. Home Office circular 009/2012 - Nurse and pharmacist independent prescribing, 'mixing of

medicines', possession authorities under patient group directions and personal exemption provisions for Schedule 4 Part II drugs. 16 April 2012

8. National Prescribing Centre. Non-medical prescribing – A quick guide for commissioners. March 2010

9. Department of Health. Evaluation of Nurse and Pharmacist Independent Prescribing. Oct 2010

10. Latter et al. Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions? An analysis of consultations. Journal of Health Services Research and Policy. July 2012; 17(3):149-156.

11. BTS Guidelines

12. NICE Guidance National Institute for Health and Clinical Excellence. Management of chronic obstructive pulmonary disease in adults in primary and secondary care. June 2010.

13. Thomas M, Kay S, Pike J et al; The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control. Primary Care Respiratory Journal; 2009; 18(1); 41-9.

14. www.catestonline.org 15. GOLD Report 2011 at www.goldcopd.org 16. Quality and Outcomes Framework. www.ic.nhs.uk/qof 17. Walters JAE, Turnock AC, Walters EH et al. Action plans with limited patient education only

for exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews issue 5: CD005074. 2010.

18. Effing T, Monninkhof EEM, van der Valk PP et al. Self-management education for patients with chronic obstructive pulmonary disease. The Cochrane Collaboration. 2009.

19. Khachi H, Hodson M, Hudson R and Parker M. COPD Self-Management: The Impact of Implementing Self-Management Plans & Rescue Medications across 3 Hospitals. European Respiratory Society Conference. September 2012.

20. Department of Health. Medicines Adherence. NICE CG76; Jan 2009. 21. McCann et al. “They come with multiple morbidities”: A qualitative assessment of pharmacist

prescribing. Journal of Interprofessional Care Mar 2012;26(2):127-133

©NHS Specialist Pharmacy Service

http://www.catestonline.org/

http://www.goldcopd.org/

http://www.ic.nhs.uk/qof



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Appendix 1 Respiratory Dataset Full details of this evaluation tool may be found on the following link: http://www.medicinesresources.nhs.uk/en/Communities/NHS/SPS-E-and-SE-England/Meds-use-and-safety/Leadership-workforce/Non-med-presc/Development-of-tools-for-self-audit-and-peer-review-by-pharmacist-non-medical-prescribers-in-non-acute-settings/

Date of Clinic

Patient Code

Age

Gender

Documented Diagnosis

Most recent FEV1 (%) (COPD) or Peak Flow (L/min) (Asthma)

For COPD patients only Most recent FEV1 / FVC ratio (%)

Documented Diagnosis Queried

For COPD patients only FEV1 rating

For COPD patients only Breathlessness MRC score (1-5)

If MRC ≥3 or hospitalisation for recent exacerbation. Referral to Pulmonary rehab made

For Asthma patients only BTS/SIGN Guidelines Steps (1-5)

CAT Score (COPD) or ACT Score (Asthma)

Number of acute exacerbations in last 12months

Number of A&E attendance/ hospitalisation in last 12months

Smoker

Smoking Cessation offered

Flu vaccination status ascertained

Referral for vaccination made

Pneumococcal vaccination status ascertained

Referral for vaccination made

Other holistic lifestyle advice given

Other holistic lifestyle advice given or other intervention(s) made

Inhaler technique assessment undertaken

General Medicines Adherence Issues identified & addressed

Access to rescue pack checked

Self-management advice given

Based on diagnosis, severity of airways disease and patient symptomology, is the drug therapy appropriate?

If no, details of action taken

Other comments

http://www.medicinesresources.nhs.uk/en/Communities/NHS/SPS-E-and-SE-England/Meds-use-and-safety/Leadership-workforce/Non-med-presc/Development-of-tools-for-self-audit-and-peer-review-by-pharmacist-non-medical-prescribers-in-non-acute-settings/





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Appendix 2 Information Governance Form Dear Doctor, We are writing to you to provide information and obtain consent to take part in a clinical audit of pharmacist prescribing in primary care. The aim of the project is:

To promote and facilitate the collection of data that demonstrates the clinical effectiveness of

the pharmacist practitioner

Project outline

1) Pharmacist prescribers have been identified and recruited in four therapeutic areas: Please tick those applicable to this practice

a. Hypertension □ b. COPD/Asthma □ c. Anticoagulation □ d. HIV □

2) A data collection form has been agreed for each therapeutic area and the relevant one attached for your information.

3) The pharmacist prescriber will be collating patient data and submitting ONLY anonymised patient data on a cohort of patients, for which they have prescribing responsibilities. Patients will be numbered 1,2,3,4…. No patient identifiable data will be submitted.

4) Data collection will take place between 1st October 2011 to 31st January 2012.

As I am sure you are aware the GMC states that clinical audit is essential to the provision of good care and indeed all health-care professionals have a duty to participate in clinical audit. It is particularly important for the development of pharmacist prescribers Section 251 of the NHS Act allows patient information to be used for clinical audit without explicit patient consent, if data are anonymised. We are writing to assure you that the data will be anonymised and that the processes of this clinical audit are within the information governance framework, ensuring that handling personal information is conducted in a confidential and secure manner. If you have any queries please contact the Lead Pharmacist Prescriber for the audit: Print Name:_____________________________________________________________________ Phone number:________________________Email:_____________________________________ _______________________________________________________________________________ Authorisation by practice (Please complete the details below and return to the Lead Pharmacist Prescriber) ___________________________ Practice agree to participating in this clinical audit (Name of GP Practice) Lead Doctor for the audit:

Name:_______________________________Signature:__________________________________ Phone number:________________________Email:_____________________________________ Date:_________________________________



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Appendix 3 Details of PIPs contributing to the project

Pharmacist independent

prescriber

Role Practice base

Shaneez Dhanji GP Prescribing Support

Pharmacist

West Wandsworth, NHS South

West London

Peggy Johnson Pharmacist Prescriber The Well Street Surgery

Hasanin Khachi Highly Specialist Pharmacist,

Specialist Medicine

Barts Health NHS Trust and

London Chest Hospital

Clare Watson Clinical Pharmacist Victoria Practice and Aldershot

Centre for Health

management of patients with respiratory disease by ... · management.4 the nhs has recently...

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