Pharmacy department

Service Innovation: Use of Pharmacy Technicians to Increase Coverage of IBA

Jacqueline Swabe & Lindsay SteelUniversity Hospital Southampton NHS Foundation Trust

Chilworth Manor Hotel27th January 2016

Pharmacy department

Context

• Two week pilot study to assess if pharmacy technician inclusion of the AUDIT C questions as part of a medicines reconciliation process increased the identification of increasing risk drinkers and allow delivery of a brief intervention or referral to alcohol care services.

Pharmacy department

Medicines Reconciliation

“the process of obtaining an up to date andaccurate medication list that has beencompared to the most recently availableinformation and has documented anydiscrepancies, changes deletions andadditions with accurate communication”Within 24 hours of admissionMedicines optimisation: the safe and effective use of medicines to enable the best possible outcomes, NICE Clinical Guideline, NG5, March 2015

Pharmacy department

Role of the Technician• To gather information from

patient/carers/relatives/ GP and other sources on what medicines the patient takes, when and how they manage them.

• To ensure the patient has sufficient supplies of medicines on discharge.

• To provide advice on how to take their medicines and to liaise with other HCP if the patient requires follow up support.

• NVQ Level 3 qualified & registered with the GPhC

Pharmacy department

Method

• Monday 16th November – Friday 27th November

• All patients, all wards• 0-5: Advise low risk drinking• 5-7: Provide an information leaflet (brief

advice)• 8+: Refer to Alcohol care team• Document time taken

Pharmacy department

Questions

• ‘I would like to ask you some lifestyle questions do you mind if I ask about your alcohol intake? As when we prescribe medications, it is helpful for us to know about people’s alcohol intake. I would like to ask you three standard questions about how much you drink.’

• ‘Based on your score, and as part of hospital policy, we would like to pass your details onto our alcohol care nurses, who will be in touch with you for a follow up, are you happy for us to that?’

Pharmacy department

Results

• Number of patients assessed: 789• By 36 Pharmacy Technicians• Across 56 wards• Audit C score 5-7: 80• Audit C score 8+: 64• Not screened: 184

Almost a quarter of patients were 5+ and received an intervention

Pharmacy department

0 1 2 3 4 5 6 7 8 9 10 11 12 18 refused to follow unable0

50

100

150

200

250

300

Audit C Scores

Audit C score

Num

ber

of P

atie

nts

Pharmacy department

Technician Attitudes - Before• Concerns about:

– Extra time– Role legitimacy– Knowledge gap (calculating units, healthy conversations)

• “I feel it is excessively intrusive”• “I am slightly concerned that some patients may

be angry or unhappy with us referring them to the service - a lot of people don’t think they have a drinking problem and they may be upset when we imply that they do”

• AA Meeting attendance

Pharmacy department

Technician Attitudes - After• Additional 6mins per history• Most patients were happy to answer and I was happy to run through

it; however I felt quite awkward when handing out leaflets to patients that had only scored 5 as I probably drink more than they do.

• I think that we are well placed to be asking people about their alcohol intake and that confidence and competence will develop with time and practice.

• I had mostly good experiences; most patients’ were happy to talk about alcohol and were happy to accept a referral. In the cases that they weren't I found that the patient's were very matter of fact and it was up to me not to take it personally.

• I felt nervous at first in case the patient was going to get defensive, but after a few times of questioning it became normal to ask the questions.

Pharmacy department

Patient Story 1• A gentleman in mid 50’s, who lived alone was admitted

to a vascular ward having coronary bypass.• Had Medicine Reconciliation taken by technician and

audit C questions asked. The patient became emotional and stated he was desperate for help. (Audit score 12)

• Patient had emergency referral the Alcohol CNS team.• Support planned as patient was moving to hospital in his

local area & social support as home was uninhabitable.• Relaying this to technician team, provided reassurance

that asking these questions was helping those in need.

Pharmacy department

Patient Story 2

• Single, professional male in his 50s• NSTEMI• High risk drinking: 100 units/week• Not identified by other routes• Referred to alcohol care team & reviewed

by Dr Sinclair• Now abstinent & commenced on relapse

prevention medication