End of Life ServicesAPTUK Conference 2013

Lisa Wall-HayesSpecialist Medicines Management Technician, End

of Life services

Friday 7th June

lisa.wallhayes@nhs.net

Hospice care

• What is the first thing that springs into your head when you think hospice?

Palliative care

• Traditionally mainly patients with a cancer diagnosis

• Now much more open to patients with other life limiting illnesses– Neurological diseases: Motor Neurone disease,

Multiple Sclerosis etc– End stage heart failure or renal failure– End stage COPD, HIV etc

Hospice care• Most hospices have

– In-patient unit• Complicated symptom management• End of life• Respite

– Day Hospice services• Self management groups• Specialist days

– Community teams/ MacMillan nurses– Hospice at Home

• We also have a Multi-Disciplinary team

Hospice care

• Only a tiny proportion of our patient are in-patients

• 14 bedded unit• 700 active patients currently known to the

hospice• Majority of our patients treated at home

Preferred place of care/death• How or where would you like to die?• Not something we like to think about or talk

about• Statistics show that most of us if given the

choice do not wish to die in a hospital• The majority of people say they would prefer

to die at home or a hospice• However currently most of us die in a hospital

Hospice vs. Hospital• Required to maintain standards as per hospital,

– CQC, Infection control, etc• We have a higher ratio of staff • Patients room within the hospice can be classified as

“temporary residence” so greater freedom allowed for patients and relatives

• More privacy and flexibility, e.g. – 24 hour visiting– Overnight accommodation for relatives– In-house chefs

• Specialist staff

Infection control lead

We don’t have one of these….

We have one of these……….

Clinical staff

Multi-Disciplinary Team (MDT)• Clinical Pharmacists• Occupational therapists• Physiotherapists• Social worker• Dietitians• Pharmacy technician

Other hospice staff• Clinical nurse specialists• Doctors• Psychotherapists• Art therapists• Counsellors/family support• Bridges (practical help)• Spiritual lead

Technician wanted• 2 Clinical pharmacists providing specialist symptom

management / medication advice• Both pharmacists :Non-Medical Prescribers (NMPs)• Increased non-clinical workload, lots of medicines

management work• Who could replace the Medicines Management

Department of the PCT?• A pharmacy technician of course

The job: Where do you start?• Legislative compliance• Policies• Audits• Cost savings• Accountable Officer support• Non-Medical Prescribing support• Research• Service development

• Medicines Information• Governance Committee• Training• Reports• Incidents• Clinical role• Specialist medication• Troubleshooting

Clinical role• Day hospice patients• FAB clinic education

sessions• Medicines reconciliation• Home visits• Adherence issues

• Assistance with medication supply issues and prescriptions

• Mobile working in the community

F.A.B-ulous patients

“Medicines Matter”

• Monthly newsletter• Latest news • Audit results• Incidents• Questions• Did you know?

Community Pharmacy “Specialist Palliative Care drugs” scheme

Background• A number of community Pharmacies have

been commissioned across the cluster to stock a specific list of palliative care drugs which will be available at all times during their opening times.

Which palliative care drugs are being held by the pharmacies in the Birmingham

area?• Diamorphine ampoules 5mg, 10mg, 30mg, 100mg• Morphine sulphate 10mg & 30mg injection• Hyoscine butylbromide (Buscopan) ampoule 20mg/1ml• Levomepromazine (Nozinan) ampoule 25mg/1ml• Midazolam ampoule 10mg/2ml• Dexamethasone ampoule 4mg/1ml• Haloperidol ampoule 5mg/1ml• Alfentanyl ampoule 500mcg/1ml• Oxycodone ampoule 10mg/1ml• Cyclizine ampoule 50mg/1ml• Metoclopramide ampoule 10mg/2ml• Water for injection 10ml AND Saline for injection 10ml• Saline 1L bag for infusion

How can we help?

“Every moment matters”

What I had to learn quickly

•If it involves drugs in ANY way it’s my job and if it doesn’t it probably is too•You can’t fix everything•Everyday is a school day•Brown towels are better than red!!!•AND…………….

Hospice staff

PCPN, Palliative Care Pharmacy Network

• National organisation• Local networks for pharmacists• Google groups• Peer support

Palliative Care needs

PHARMACY TECHNICIANS

Thank you

Any questions?

“Every moment matters”

“ The question is not whether we will die, but how we will live”

Dr J Borysenko

“As a well spent day brings a happy sleep so a

life well used brings happy death”

DaVinci

“Every moment matters”