Option 4 - National NSAID communication bundle: Improving medicines safety in frailty patients

Theme 4 considers How Can Medicines Safety Be Improved?

Mark Easton has been a community pharmacist since 1986, currently working in the independent sector in the Moray coastal villages of Hopeman and Burghead, having previously worked for Boots in a number of locations across Scotland and the north of England. Mark joined the Scottish Patient Safety Programme (SPSP) Pharmacy in Primary Care collaboration when NHS Grampian was selected as one of the four Boards in the pilot work and assumed the NHS Grampian clinical lead role following a personnel change within the local steering group. He is currently seconded to Healthcare Improvement Scotland as national clinical lead pharmacist within the primary care portfolio. His motivation after 30 years? He loves the day job because every day he has opportunities to make a difference to the health and wellbeing of real people with real needs.

‘National NSAID communication bundle’

Non-steroidal anti-inflammatory drugs (NSAIDs) have the potential to cause significant preventable harm and are associated with more emergency hospital admissions than any other class of medicines. As a way of reducing harm associated with NSAIDs, a communication care bundle was developed by the SPSP with four Health Boards to support the delivery of key information to patients being supplied with NSAIDs from a community pharmacy. Initial testing of the bundle was followed by a review and retesting within the Pharmacy in Primary Care Collaborative until a consolidated bundle was agreed. In November 2017, the Scottish Government included implementation of the bundle in the community pharmacy contract as Quality Improvement element, and Healthcare Improvement Scotland were responsible for developing and distributing a toolkit to support the pharmacy teams. This toolkit, issued in May 2018, provides teams with guidance on the bundle and tools to enable collection of data for improvement.

Lowri Davies works as part of the innovative Frailty and Chronic Conditions Cluster based in the Teifi Valley, West Wales. The team consists of Frailty Nurses and Frailty Pharmacists and their aim is to provide a holistic frailty review encompassing physical, psychological, social and medication issues within the home environment. Early intervention aims to avoid unnecessary polypharmacy and crisis management and to reduce unplanned Hospital Admissions. Lowri graduated from the Welsh School of Pharmacy with First Class Honours and also completed the Post Graduate Clinical Diploma from Cardiff University with Distinction. Lowri has a background in secondary care working as a Specialist Clinical Pharmacist with an interest in Cardiology, also training as an Independent Prescriber. During her time in secondary care Lowri experienced a variety of clinical specialties, thus enriching her clinical knowledge and expertise.

‘Improving medicines safety in frailty patients’

Frailty is a clinically recognised state of increased vulnerability. It results from ageing and cumulative decline in the body’s physical and psychological reserve. Polypharmacy is common in the older generation with 45% of all medications prescribed in the UK being for patients over 65years old. NICE guidance evidence suggests that polypharmacy is associated with increased risk of unplanned hospital admissions and mortality and also recognises that optimising a person’s medicines can support the management of long term conditions. With this in mind it is paramount that care is taken when prescribing for this population. Regular medication reviews are recommended in order to avoid polypharmacy, ensure that the most appropriate evidence based medications are prescribed and that unnecessary harm is avoided. As pharmacists we are ideally placed to carry out these medication reviews and have a vital and exciting role to play in this field in the future.