Falls Prevention & Inhaler Service Update Training

Claire Thomas

Agenda7.15pm Introduction7.20pm Falls Prevention Service

Evaluation7.30pm Practice Scenarios8.10pm Feedback and Q&A Session

8.20pm Inhaler Check Service Evaluation 8.30pm Practice Scenarios 9.10pm Feedback and Q&A Session9.20pm Summary & Close

Falls Service Experiences so far Please write down 3 things/key

words you would like to share/address regarding your experiences so far of delivering the falls prevention service.

Falls Prevention Service Evaluation Background Service description Aims & objectives

Setting and MethodsSetting: 23 community

pharmacies across Doncaster.Methods: Audit of 414

consultations, analysis of 353 patient satisfaction questionnaires & a face-to-face meeting with a Falls Co-ordinator. Analysis involved descriptive statistics & qualitative comments a thematic approach.

Results

High

Risk Med

icin

e (n

=41

4)

Side

Effec

ts (n

=41

3)

Afrai

d of

Fal

ling

(n=41

3)

Balan

ce/g

ait P

robl

em (n

=41

1)

Visio

n Pr

oble

m (n

=41

3)

Urinar

y Con

tinen

ce P

robl

em (n

=41

2)

Fall in

last

12

mon

ths (n

=41

2)

94.9

31.517.4 22.6 22 22.1 21.8

Risk Factors Identified

Percentage of Patients

Results

High-risk medicine Side effects Afraid of falling Balance/gait problem Vision problem Continence problem

22.3

31

65.3

42.9

27.8 27.6

Risk Factors and Falls

Percentage of patients who have fallen in the last 12 months

Results>50% of patients who had

suffered a fragility fracture were not prescribed bone-sparing medication

37% reported compliance problems

Majority of consultations resulted in interventions provided by the pharmacist

Feedback from patients & Falls Co-ordinator was positive

Future Service Development

Extend service to include domiciliary consultations

Referral of patients presenting at A&E following a fall into the service

Introduce an element to the service to try & reduce the number of medicines being taken by patients

Develop a community pharmacy osteoporosis screening service

Evaluation ConclusionPharmacists can successfully identify patients at risk, provide patient education and make appropriate referrals to the specialist falls clinic.

This new and unique service should continue. Patient satisfaction with the service is high, it is supported by the specialist falls service and it is accessing patients who are not accessing other services.

Practice Scenario4 questions to discuss in groups5 mins to agree group answer5 mins for debate

Feedback and Q&A“Support was amazing after poor service from DRI A&E. The pharmacy has done more to support my falls and reduce readmission to A&E which is for me a step in the right direction” Falls Service Patient“The service is beneficial, it is accessing a group of patients that might not be accessing other services”. Falls Co-ordinator SFS

Additional ResourcesConsultation skills for pharmacy practice:

taking a patient-centered approach. CPPEFalls: assessment and prevention in older

people. NICE guideline 161 available at: http://www.nice.org.uk/guidance/cg161

Medicines and Falls in Hospital: Guidance Sheet available at: https://www.rcplondon.ac.uk/sites/default/files/documents/medicines-and-falls2.pdf

Age UK www.ageuk.org.uk

Inhaler Service Experiences so far Please write down 3 things/key

words you would like to share/address regarding your experiences so far of delivering the falls prevention service.

Inhaler Check Service Evaluation Background Service description Aims & Objectives

Setting and MethodsSetting: 29 community

pharmacies across Doncaster.Methods: Audit of 616

consultations and analysis of 577 patient satisfaction questionnaires. Audit and questionnaire results were analysed using descriptive statistics, qualitative comments using a thematic approach.

ResultsCost: £7561.50 8.6% of patients unsure of their

diagnosisMajority of patients prescribed a

MDI400 patients had an initial IR out of

the target range for their deviceOver 98% of patients achieved

target range by the end of their consultation

MDI Inspiration rate Results

MDI Use & Previous Instruction

Results cont.Condition Control: high reports of

regular preventer use. Almost half of patients needed to use their reliever inhaler once or twice daily or more.

Interventions: Most common intervention was inhaler instruction. Little need to contact the GP/practice nurse

Patient feedback: Extremely positive

Future Service Development

Supply of spacers with/without masks

Include full assessment of condition control (ACT/CAT)

Follow-up consultations to monitor performance and outcomes

See patients after asthma attacks/exacerbations ?referral from A&E

COPD exacerbation management

Evaluation ConclusionResults demonstrate the need for

regular inhaler technique checks Community pharmacists have a key

role in improving inhaler technique, complying with current guidelines

The service is beneficial to patients & the NHS; improving inhaler use can improve condition control improving quality of life, reducing hospital admissions & even deaths, funding should continue

Practice Scenarios4 questions to discuss in groups5 mins to agree group answer5 mins for debate

Feedback and Q&A

“Thought I was good using inhalers but learnt a lot from the pharmacist that will help me” Inhaler Check Service Patient

“Pharmacist was exceptionally helpful and explained everything in detail. This made me feel more confident” Inhaler Check Service Patient

Additional Resources Inhaler technique videos available at:

https://wessexhiecpartnership.org.uk/wires/video-series/inhaler-technique/

COPD guidelines available at: http://www.nice.org.uk/guidance/CG101

COPD learning resources available at: http://www.thelearningpharmacy.com/content/learningtopics.asp

Asthma guidelines available at:https://www.brit-thoracic.org.uk/guidelines-and-quality-standards/asthma-guideline/

National review of asthma deaths available at: https://www.rcplondon.ac.uk/projects/national-review-asthma-deaths