Flashcards in Community Pharmacy Services Deck (33):
What are the main ways pharmacies get their income from?
1. Essential services
2. Advanced Services
3. Locally commissioned services
4. Private prescription services
5. Private pharmacy services
6. Pharmacy sales
What are the essential services pharmacies must provide?
2. Repeat dispensing
3. Promotion of healthy life style choices and counselling
4. Disposal of unwanted medicines
5. Sign posting patients to other health care providers
6. Support for self care
7. Clinical governance (maintaining quality and support of all services)
Describe the essential service of dispensing?
1. The supply of a medicine, chemical reagent, appliance or other allowable substance against an NHS prescription that's written by an authorised prescriber
2. Supply is made at a reasonable time, clinical interventions, ownings and referrals must be recorded in the patient medication record (PMR)
3. Standard operating procedures must be in place
4. Drug tariff and collection of dispensing fee must be in place or exemptions
What are some essential services that are a part of dispensing that can be offered to patients?
1. Delivery to care homes
2. Dosette boxes prepared for ease of use (care home services) (aka managed repeat services)
3. Prescription collection service
Describe the general patient collection service?
1. Patient visits GP's and orders their medication
2. Patient visits pharmacy and hands in prescription
3. Pharmacy orders and supplies items from the GP surgery to patient in return for prescription
Describe the keep repeat service?
1. Pharmacy keeps the repeat slip on the prescription which is filled out by the patient
2. The patient's address, mobile number and email in order to collect medication
3. Pharmacy orders medication from the GP surgery and collects the prescriptions
Describe the managed repeat services?
1. Pharmacy orders items
2. sorts out prescription for patient
Describe what compliance aids are?
1. 7 day a week package
2. Each pack has sections of: morning, evening and bedtime
3. Tablets and caplets are put into the appropriate dossette boxes and NOMAD
Describe how the care home services work and what is a MAR chart?
1. Medication is packaged into individual blister packs that are colour coded for different times of the day
2. Medicines Administration Record (MAR) is used at the time of dispensing by care home staff to record administration to patients
3. Care home is responsible for these services
Describe the repeat dispensing service?
1. A patient can have up to 12 prescriptions (12 months worth) or 6 prescriptions (6 months worth) without having to return to GP
2. This should only be provided on patients on stable medication and pharmacists ensure the responsibility of repeat supply
3. This comes in RA (repeat authorisation) and RD (repeat dispensing) form
Describe the essential service of disposal of waste medication?
1. Unwanted or out of date medication can be disposed of by the patient
2. NHS provides financial support for waste collectors
3. SOPs must be followed in terms of waste disposal to ensure safety
4. CD destruction kit's must be provided to denature CD's
5. No sharps or chemicals
6. Waste from care homes can be accepted but at an additional charge
Describe the essential service of promotion of healthy lifestyle management?
1. You must provide advice on patients judging their prescriptions on:
- hypertensive and high cardiovascular risk
2. Promotion of healthy lifestyle to all
3. Take part in local and national health campaigns
4. Document each action
Describe the essential service of promotion of self care support?
1. Self limiting illness (responding to symptoms) and long term conditions
2. Document interventions
Describe the essential service of promotion of sign posting?
1. Pharmacist cannot provide all the help and information, may have to see:
2. Support groups
3. Information services: dial 111
4. Other healthcare professionals
5. Local NHS or service
What are the five optional advanced NHS services?
1. Medicines Use Review
2. New Medicines Review
3. Flu vaccinations
4. Appliance use review service
5. Stoma Appliance customisation service
Describe the advanced service of medicines use review?
1. Aim of the process is for patients to have a better understanding of their medication and adherence
2. Done by:
- Establishing patients actual use, understanding and experiencing taking medications
- Identifying poor use of medication, if they take it and efficacy of it
- Identifying interactions and side effects that may affect adherence
- Improving clinical and cost effectiveness of prescribed medicines to reduce medicine wastage
What must a pharmacist have done before being allowed to do an MUR?
1. Accredited though a course
2. Have a stable view of clinical governance
3. Can complete the essential services at a high enough level
4. Have a consultation room available
5. Appropriate SOP's in place
What are the requirements that must be passed in order to ensure a patient is eligible for an MUR?
1. Must take two medicines that are of chronic conditions (one has to be a high risk medicine)
2. Must be using the pharmacy for a previous of 3 months
3. Not had an NMS in the last 6 months
4. Not had an MUR in the last 12 months
5. Must be able to have signed consent
Describe what an intervention MUR (prescription intervention) is?
Where you can disobey the requirements necessary for an MUR if there's suspicion that they need one
Who should you target MURs based on?
1. High risk medication their taking:
2. Patients recently discharged from hospital
3. Patients with respiratory diseases (asthma or COPD)
4. Patients at risk and diagnosed with cardiovascular disease and have been prescribed 4 medications
- Coronary heart disease
- Heart failure
- Renal or chronic kidney disease
Describe the advanced service of new medicines review?
1. Patients have chance to manage their long term condition of their newly managed medication to improve medicine adherence
2. Split in 3 steps:
- Patient engagement (Day 0)
- Intervention (Day 7 to 14)
- Follow up (Day 21 to 28)
What are the requirements that must be passed in order to ensure a patient is eligible for an a new medicines review ?
1. Starting new treatment thats for conditions such as:
- Asthma or COPD
- Anti-platelet or coagulant therapy
- Diabetes (Type 2)
2. Selected due to greatest degree of non adherence
3. Benefit most from the service
4. Must be a new drug molecule and not a different formulation
What are the benefits of a new medicine service?
1. Improves patient adherence
2. Increases patient engagement with their medication and decisions
3. Reduces waste of medication
4. Increases use of yellow card scheme if any adverse reactions reported
5. Positive assessment from patients
6. Reduced hospital admission related from adverse reactions
7. Supports development of outcome and quality measures for community pharmacy
Explain how you know when a patient is eligible for a flu vaccination?
1. Over 65
2. At risk groups such as:
- Children 6 months to 2 years old
- Adults aged 18 or over
- 2 to 17 cannot have "Fluenz" vaccination
3. Other at risk groups are:
- Pregnant women
- Care home residents
- patients with long term conditions such as respiratory illness, cardiac, hepatic or renal impairment, immunological disorders
How do you administer or supply a POM without a prescription?
1. Patient group direction (PGD) or patient specific direction (PSD)
2. Verification of online and face to face training
3. Standard operating procedures: can provide POM during an emergency
4. Regular renewal and review of training contract
Describe what a PGD is?
1. An instruction list of a frame work to follow for the supply or administration of medicines to a group of patients for prophylaxis or treatment specified
2. No prescription is needed but stills needs to be recorded in the PGD section
3. Labelling requirements still need to be provided if patient takes medication home
Describe what the PGD (patient group direction) document must contain?
1. Written and signed off by the doctor
3. Clinical condition or situation this PGD applies to
4. Staff authorised to supply this medicine under PGD
5. Treatment available under PGD
6. Facilities and supplies to be made
7. Managing and monitoring of patient group directions
Explain what a PSD is?
1. Patient Specific direction
2. Same as PGD but it's tailored to a specific patient or list of patients held by the GP or prescriber
3. For example: warfarin or vaccines may be supplied as part of the warfarin clinic service
What is the training required for a PGD in flu vaccination?
2. Basic Life support
3. Injection technique: intramuscular or subcutaneous
4. E-learning and E assessment
After providing a flu vaccination, what must be done afterwards?
1. Inform patients GP after flu jab to:
- collate national flu vaccination record
- Addition to medical records
- Ensure patient isn't vaccinated twice
2. Questionnaire must be completed
3. Claim cost from NHS BSA
Who pays for enhanced services?
1. Clinical commissioning groups
2. Public health England via authorities
3. NHS England
Describe what the locally commissioned sexual health services are?
1. Chlamydia testing kit
2. Azithromycin provision for treatment of Chlamydia
3. Condom supply
4. Mainly funded by the council