This peer support system has been established to support pharmacy technicians working in clinical roles in care homes and domiciliary settings.
NICE guidance NG 5 (Medicines Optimisation) section 1.4 and NICE guideline SC 1 (Managing medicines in care homes) section 1.8 contain recommendations about medication review. This peer support service is an example of an intervention put into practice in order to support the implementation of these recommendations.
Example
Aims and objectives
• To provide peer support and learning through case scenario review
• To share good practice through regular face to face discussions
Reasons for implementing your project
The number of pharmacists and pharmacy technicians working in clinical roles in care homes and domiciliary settings is slowly increasing, often involving the care of complex older adults. A number of these post holders work in isolation without adequate support from their organisational structure and would therefore benefit from peer support.
Feedback from various pharmacy networks and running learning events as well as mentoring and supporting local pharmacists, indicated that more often than not, adequate senior clinical pharmacy support was lacking within their organisational structures. Although many had the clinical knowledge to undertake medication reviews, they needed support and confidence to apply them in the complex patient situations they encountered in practice. Also there was a need to develop the skills to co-ordinate, lead and deliver medicines optimisation for the patient within wider community integrated teams for older people. So it was decided to pilot peer support meetings where pharmacists can discuss face to face with colleagues, to gauge the need, identify the key issues as well as test the value of providing such support.
The analysis of feedback from three facilitated peer group meetings held in London confirmed that that there is a need and attendees found the networking and participating in the face to face peer review useful. Improved clinical knowledge in the care of older people and the ability to apply clinical knowledge in complex situations as well as delivering better patient centred care were the main areas that will positively impact on their daily practice.
How did you implement the project
Pharmacist involved with undertaking medication reviews for frail older people in the community setting (domiciliary or care home settings) as part of their role were targeted. Notification of the event was posted on the Royal Pharmaceutical Society (RPS) virtual groups (Domiciliary care and Care homes). Also emails were sent via NHS Specialist Pharmacy Services to the Older People Pharmacy network (Group of NHS primary and secondary care pharmacists with an interest or working with older people, who attend yearly learning events run by NHS Specialist Pharmacy Services) and also directly to pharmacists who had been in contact with queries or for shadowing opportunities. Numbers were limited to 25 on a “first come, first serve basis”. The NHS pharmacists attended within their working day as they would for most learning events to support their continuing professional development in their role.
Each meeting follows a set format and is structured around two anonymised real life case scenarios (one domiciliary & one care home) and the group works through each of the cases with a facilitator (the Consultant Pharmacist care of older people). A resource has been developed to support this innovation which includes suggestions for the role of the facilitator and other tools. The case scenarios were presented in a template developed by the facilitators and circulated at least a week prior to the meeting. It included a list of the patient’s drugs as well as background information typical of what the pharmacist will have access to in the community e.g. from a TTO or GP record summary.
After the welcome and introductions, each case was presented and discussed in small groups of 5-7. The discussions focused on obtaining further information particularly, from the patient or their carer to identify the medicines related problems and enable patient-centred interventions to be made. The larger group reconvened and facilitators provided information based on what happened in the real case to form the basis for the facilitated discussions to explore a number of options, and eventually the preferred option i.e. the safest intervention(s) that meet the individual patient’s identified need and experience. Therapeutic, clinical, ethical and statutory issues on various aspects of the medicines pathway were discussed in detail as they arose and references made to relevant guidance to justify or back up the decisions made.
Key findings
The format provided a non-threatening, relaxed environment to work through common issues, ask questions, exchange ideas and solutions as well to reflect on the key learning points and how it may apply to everyday clinical practice. The meetings allowed the pharmacists to gain more information and knowledge about best practice in medication review, in line with NICE recommendations and to share in a safe environment. A lot of the learning was around patient centred consultation skills to engage with older patients and elucidate the best information from them so that the right plan of action can be agreed to optimise medicines use. Pharmacist and technicians from different operational settings were able to give their opinion of how they would deal with the situation presented in the real life case studies, sharing experience of the different ways and range of wider contacts they use in their organisations to support medicine optimisation for older people.
Feedback from Meetings 86 people (81 pharmacists and 5 technicians) have attended 5 meetings (4 in London and 1 in Leeds) and evaluation of feedback from each meeting has been positive.
When asked about the best aspect of the meetings, the top reasons were:
• Networking
• Peer review of the cases
• Group discussions and sharing ideas
Key learning points
• Use resources provided as a starting point and adapt to suit your local need BUT don’t reinvent the wheel!
• Identify your local group and test the need for this type of support. As it’s a peer group and very interactive, the attendees have to be motivated and willing to be a part of it to get the best out of the meeting.
• The Facilitator role is key, must be credible and have good local standing
• Avoid the temptation/pressure to use traditional teaching style as these can be accessed via usual pharmacy learning events, CPD, training and education routes