Using your inhalers correctly: The Asthma Series

by Kazeem Olalekan MRPharmS

Inhaler technique is a significant factor in proper management of Asthma and COPD. Medicines Use Reviews in Pharmacies, Nurse-led clinics and Hospital-based clinics are useful places where good inhaler technique can be re-enforced. There is no harm in reviewing patient’s technique regularly because it is difficult to kick out old habits and even more difficult to learn new tricks. It is with pleasure therefore, that I share with you the following videos produced by an Independent, Not for profit and Evidence based Australian outfit know as NPS MedicinesWise (Website | Youtube) {NPS – National Prescribing Service?}.

  1. How to use an asthma metered dose inhaler (MDI)

  2. How to use an asthma Turbuhaler

  3. How to use an asthma Handihaler

There is more….I have embedded the playlist below. I will now go and practice my own inhaler techniques….

How saving a penny can cost you a pound…

by Kazeem Olalekan MRPharmS

You know the deal: Prescribe generically and you can save a lotta cash for the NHS. In most cases this is true and laudable, after all, there is very little of the crisp stuff doing the rounds. So you might understand the need to switch from a prescription of Voltarol Emulgel 1% (at a BNF cost of £5.63/100g)  to generically prescribed Diclofenac gel 1%. That should save a few bob! The only problem is that there is no currently licensed generic Diclofenac gel 1% (I stand corrected). Even if there is, the Tariff price for a prescription of Diclofenac 1% gel 100g is still £5.63. A prescription switch thus have not cost benefits.

The Problem:

In attempting a switch, another Diclofenac (i.e. 3%) is being picked because that is the first one that comes up on the system (after all there are so many different variations of Diclofenac!). It is an easy mistake to make when confronted with such big array of options. This is of course not clinically appropriate if all you are trying to relieve musculoskeletal pain. The 3% strength is licensed for actinic keratosis – that is sun skin damage to you and me. Oh…and by the way, a 100g tube of this stuff costs £76.60 (BNF).

solaDiclo_

Solution:

So in an attempt to prescribe generically, we have prescribed the wrong product and £70.97 worse off! I think we should prescribe this by brand…don’t you?

 

My Conference Notes 3: The unfinished observation

by Kazeem Olalekan MRPharmS

Last year, I started a series of blogs of reflection on my experience at the Pharmacy Management National Forum. I promised to write 5 blogs on my observations but in the end, I only managed 2! It has nothing to do with having nothing to write. On the contrary: I have a lot to write but time conspired against me. What I want to reflect upon are still very relevant today.

One year on, I find myself attending the second conference on the 12th of November 2013. The forum entitled: The Journey Continues, builds on the previous year’s conference and yes, you guess it, I have made a few more notes! This is the  plan: Over the next few months, I will share with you my thoughts on last and this year’s conference in a series of posts totalling 15…..yes 15! You can hold me to account on that.

There is so much happening in Pharmacy at the moment that a considered reflection is needed on my part to make sense of this period of flux we are experiencing. Clearly I am as keen as ever to take my patients with me and to help colleagues navigate the labyrinth, that is the new NHS.

 

 pm_conference

 

Previous related posts

My Conference notes 1: Pharmacy Management National Forum

My Conference notes 2: What is Medicines Optimisation?

What’s New? The BNF and BNFc updates

by Kazeem Olalekan

A BNF and BNFc app convert like myself knows to press the ‘Update Now’ button whenever I am prompted to do so. It is the best way to be up-to-date in clinical decision making. What I thought I would do today is highlight some key updates in the BNF and BNFc in the latest update – November 2013.

 

BNFc – British National Formulary for Children (Updates)

Use of Codeine in Children

avoid_codeineD id you know that the use of Codeine as an analgesia in children is now restricted! This is because of reports of morphine toxicity. I don’t want to bore you with the intricate details of why this is a problem but it is to do with the variability in codeine metabolised in children. The important take home message is:

Codeine SHOULD only be used to relieve acute moderate pain in children older than 12 years and ONLY if it cannot be relieved by other painkillers such as paracetamol or ibuprofen.

Codeine is contra-indicated in all children (under 18 yrs old) who undergo the removal of tonsils or adenoids for the treatment of obstructive sleep apnoea.

A Drug Safety Update is available on the MHRA Website

Metoclopramide: Risk of neurological adverse effects

Following a risk-benefit analysis by the European Medines Agency’s Committee on Medicinal Products (CHMP) for Human Use, it was concluded that the risks of neurological effects such as extrapyramidal disorders and tardive dyskinesia outweigh the benefits in long-term or high-dose treatment. The following advise was recommended to minimise potential risk:

In children aged 1 – 18yrs, metoclopramide should only be used as second-line option for prevention of delayed chemotherapy-induced nausea and vomiting.

Use of metoclopramide is contra-indicated in children aged under 1 yrs.

Used for short-term use (upto 5 days)

More information available here

Oral Ketoconazole? Forget it!

Oral ketoconazole: do not prescribe or use for fungal infections—risk of liver injury outweighs benefits

More information here and here

...and more

There are more updates relating to:

  • Pertussis
  • Colistimethate
  • Malaria prophylaxis
  • Driving guidance with diabetes
  • Vaccination in children

Please take time out to keep up-to-date.

BNF – British National Formulary (Updates)

Mirabegron for treating symptoms of overactive bladder

NICE recommends mirabegron as a possible treatment for the symptoms of overactive bladder in some people (see below).

Who can have mirabegron?

You should be able to have mirabegron if drugs called ‘antimuscarinics’ do not work, if they are not suitable for you, or their side effects are unacceptable.

Why has NICE said this?

NICE looks at how well treatments work, and also at how well they work in relation to how much they cost the NHS. NICE recommended mirabegron because the benefits it provides justify its cost.

Details available here

A traveller? You need to know about Rabies

Rabies is a very serious viral infection that targets the brain and nervous system. You can catch rabies if you are bitten by an infected animal and haven’t been vaccinated (link). Vaccines are used for pre- and post- exposure prophylaxis.

Want to know your risks?

Visit

National Travel Network and Centre;

or

Health Protection Scotland

...others

  • Like changes to the loading dose of Lacosamide
  • Like new product: Aflibercept: VEGF-A, VEGF-B binder. NICE recommends use for wet AMD.
  • Dapagliflozin in combination therapy for treating type 2 diabetes. NICE

Please take time out to keep up-to-date.

 

 

 

 

 

Dementia: A priority in Hampshire

dementia2

by Kazeem Olalekan MRPharmS

dementiaThe dilemma of Dementia was brought into sharp focus for me recently when I attended the events organised by the Wessex Local Pharmacy Forum. The event took place on the 14th of October at Holiday Inn Eastleigh.  Stephen Bleakley, Deputy Chief Pharmacist at Southern Health NHS Foundation Trust and a representative from Hampshire Dementia Action Alliance, Debbie made powerful cases for keeping this at the very top of our professional agenda.

 

National Lead:

At a national level, the Department of Health set out a national Dementia challenge in March 2012 led by Prime Minister David Cameron to tackle one of the most important issues we face as the population ages. The key area aims of the strategy are:

  • Improve Awareness
  • Earlier diagnosis and intervention, and
  • Higher quality of care.

The questions I always ask in cases like this is where do I fit into the overall strategy? How will my practice change? How can I make a difference?

The anguish faced by people living with dementia was brought to my door step by the story featured in the Express, where Lady Sally Grylls, mother of that TV adventurer Bear Grylls, described a scenario where frail and elderly patients lay in agony, confused, isolated and terrified with no one to reassure them! She lives in Hampshire & Isle of Wight – my patch!

How can I, as a pharmacist, respond to the challenges posed by Dementia?

I attended the Wessex LPF event for a start!

Stephen Bleakley did a great job in refreshing my memory about the condition. Dementia, he observed, is a progressive degenerative neurological disease. About 800,000 people in UK have Dementia and the figure is expected to double over the next 30 years! The symptoms may include ongoing decline of the brain and its abilities and may include:

  • memory loss
  • thinking speed
  • mental agility
  • language
  • understanding
  • judgement

More information on condition is available on the NHS Choices website.

The types of dementia include:

Stephen Bleakley’s talk introduced us to a Mini Mental state Examination toolkit (MMSE) which is an assessment toolkit most commonly used to test for complaints of memory problems. The Alzheimer’s society has produced a fact sheet the MMSE here. This is of course a validated proprietary tool which is available to buy through Psychological Assessment Resources (PAR).

CHALLENGE ONE

If the national strategy, is for early diagnosis, then this tool should be available for use by the front line pharmacist supported by training on appropriate use of the tool. Suffice to say the aim is not to diagnosis (that is not our role), but to provide early indication of potential problem.

In general, scores of 27 or above (out of 30) are considered normal. However, getting a score below this does not always mean that a person has dementia – their mental abilities might be impaired for another reason or they may have a physical problem such as difficulty hearing, which makes it harder for them to take the test. In any case, it provides an objective starting point in our contact with patients. It may form part of the Medicines Use Review Service.

Stephen then went on to describe pharmaceutical agents currently available for managing patients living with dementia:

  • Acetylcholinesterase inhibiting drugs such as Donepezil, Galantamine and Rivastigmine
  • N-methyl-D-aspartate (NMDA) antagonist sometimes known as glutamate receptor antagonist such as Memantine

There is a NICE guideline (TA217), which discusses the place of each treatment in the management of Alzheimer’s

Stephen further went on to describe the role of other pharmaceutical agents in the management of comorbid symptoms:

  • Benzodiazepines may increase the risk of falls
  • Anti-depressants have mixed effectiveness and risk vs benefit must be carefully considered
  • Mood stabilisers like Carbamazepines and Valproates may be considered where appropriate

As far as managing people with dementia, the best practice is identified in the NICE Dementia Guideline CG42 and Dementia Quality standards.

CHALLENGE TWO:

What do I know about the key drugs used in managing dementia?

Donepezil

  • Indicated for mild to moderate dementia in Alzheimer’s disease
  • start at 5mg daily at bedtime, then increase if necessary after 1 month to maximum of 10mg daily
  • Common side effects include: nausea, vomiting, anorexia, diarrhoes, headache and dizziness
  • Caution in mild to moderate hepatic impairment (Metabolized by CYP2D6 and CYP3A4)
  • The elimination half-life is approximately 70 h
  • Formulated as tablets and orodispersible tablets

Galantamine

  • Indicated for mild to moderate dementia in Alzheimer’s disease
  • start at 4mg BD for 4 weeks, increase to 8mg BD for 4 weeks; maintenance 8-12mg BD (normal release tablets)
  • start 8mg OD for 4 weeks, increase to 16mg OD for 4 weeks; maintenace 16-24mg OD (M/R tablets)
  • dosing adjustment required in hepatic impairment – see BNF
  • Avoid if eGFR less than 9ml/minute/1.73m2
  • Common side effects include: nausea, vomiting, anorexia, diarrhoes, headache, dizziness, weight loss, hypertension and bradycardia.
  • The elimination half-life of galantamine is about 7-8 hours
  • Available tablets, M/R tablets (The extended release formulation of galantamine, galantamine-ER, is a capsule composed of pellets. While 25% of the dose is in an immediate release form, the remaining 75% is in a controlled release form) and oral solution.
  • Great article

Rivastigmine

  • Indicated for mild to moderate dementia in Alzheimer’s disease
  • oral: start at 1.5mg BD, increase in steps of 1.5mg BD at intervals of at least 2 weeks according to response and tolerance; usual range 3-6mg BD; maximum 6mg BD. IF TREATMENT IS INTERRUPTED FOR MORE THAN 7 DAYS, TREATMENT SHOULD BE RETITRATED FROM 1.5mg BD.
  • patch: initially 4.6mg/24hrs patch and increase after 4 weeks; usual mantenance 9.5mg/24hrs; after 6 months may be increased to 13.3mg/24hrs (caustion if weight is less than 50kg). IF TREATMENT IS INTERRUPTED FOR MORE THAN 3 DAYS, TREATMENT SHOULD BE RETITRATED FROM 4.6mg/24hrs.
  • The strategy for switching from tablet to patch is in the BNF.
  • Common side effects include: nausea, vomiting, anorexia, diarrhoes, headache, dizziness, weight loss, hypertension and bradycardia.
  • Patches are less likely to cause GI side effects
  • Half-life after patch administration 3.4hrs; capsules 1.5hrs
  • Take oral with or after food
  • Available as capsules, oral solutions and patches (counsel on how to apply – see BNF)

Memantine

  • Indicated for mild to moderate dementia in Alzheimer’s disease
  • start 5mg OD, increase in steps of 5mg at weekly intervals to maximum of 20mg OD
  • Use with caution in patients with history of convulsion
  • Avoid in severe hepatic imparement
  • Reduce dose to 10mg OD if eGFR 30-19ml/minute/1.73m2
  • Important interactions with OTC medication: DEXTROMETHORPHAN
  • half-life 60-80 hrs
  • Available as tablets and oral solution

Apart from the above, how else can we help as pharmacists?

CHALLENGE THREE:

dementia

With this post, how is bookapharmacist.com doing it’s bit for Dementia?:

  • Improving public and professional awareness and understanding
    of dementia
  • Good-quality early diagnosis and intervention for all
  • Good-quality information for those with diagnosed dementia
    and their carers
  • Enabling easy access to care, support and advice following
    diagnosis
  • Development of structured peer support and learning networks
  • Improved community personal support services
  • Put Dementia on the Pharmacist agenda

At the end of the Wessex LPF event, I interviewed some pre-registration pharmacists. These were their comments:

http://youtu.be/_3qsmyXa4YU

<end>

 

When Kazeem met Perveen…

by Kazeem Olalekan MRPharmS

perveen_cover
It was in March 2007 when I made a proposition to Perveen about a project I was planning. It was a simple and direct proposition. It went something like this:

‘Hello Perveen how are you and the family? Hope all is well. I am planing a MUR project: you know the same MUR that most people seem to be against. It will take about a year and will cost about £x. There is no guarantee that it will be successful but the amount you put down will be your proportional stake in the project. I just feel that this MUR thing is very important to what we do as pharmacists and will be glad if you can come on board.’

Perveen said:

‘I will think about it and get back to you in about a week’

I went away hoping against hope that he would say yes to my proposition. Judging from the precarious position of my finances (Doctrine of Universal Truths), there was no way I could have embarked on the project without some financial support from my colleagues.

In the end, I needn’t have worried. He was the first person to say yes and I observed in my ‘Doctrine of Universal Truths‘ that:

When first floated the idea of an MUR project, he was the first person to say yes. He not only said yes – he also put down the highest sum of money……For what was a blank canvas, I saw this as a vote of confidence in me.

It will appear that our missions were aligned.

In September 2013, I sat with Perveen to do an interview and I was blown away…again! He is now a husband and a dad. I present our Case Study 9 interview of Perveen Bhardwaj – Now an Area Manager with Rowlands Pharmacy. Click here for the interview.

The following are some quotes:

A big part of that was being able to make a difference both in the profession and lives of patient

 

We shouldn’t loose the fact that there is a great clinical need (for MUR).

 

For people who do fail, it is not the end of your career; it seems bad at the time but it I feel it made me a better pharmacist by making me go over things I didn’t know the first time.

Cummulative Update

mhra
by Kazeem Olalekan

Over the last month, a number of important alerts have been posted on the MHRA website which we, at bookapharmacist.com, will like to draw attention (NOTE: We continue to Tweet MHRA alerts on our Twitter page – @bookapharmacist under the hashtag #mhra – so be sure to follow our tweets):

 

29/10/2013 – Class 2 Alert – Imigran Injection/Subject

GlaxoSmithKline UK are recalling the above batches of Imigran Injection/Subject to pharmacy, clinic and wholesaler level as a small number of syringes may have needles protruding from the needle shield.

Affected batches

Imigran Injection/Subject

Description Batch number Expiry date Pack size
Imigran Inj/Subject Treatment C640404 15 May 2015 2×0.5ml
Imigran Inj/Subject Refill C639899 4 June 2015 2×0.5ml
Imigran Inj/Subject Treatment C638748 4 June 2015 2×0.5ml
Imigran Inj/Subject Refill C638737 4 June 2015 2×0.5ml
Imigran Inj/Subject Treatment C636954 4 June 2015 2×0.5ml
Link

 25/10/2013 – Class 2 Alert –  NovoMix 30 Penfill, 100U/ml, 3ml, Suspension for Injection and NovoMix 30 FlexPen , 100U/ml, 3ml, Suspension for Injection

Novo Nordisk A/S is recalling the batches of above insulins due to the possibility of a very small number of cartridges within each batch containing too much or too little insulin.

Novomix 30 Penfill, Distributed in the UK by Novo Nordisk Ltd

Batch number Expiry date Pack size
CS6D422 Oct 2014 5 x 3ml
CS6C628 Sep 2014 5 x 3ml
CS6C411 Aug 2014 5 x 3ml
Link

Novomix 30 FlexPen, Parallel Distributed in the UK

Batch number Expiry date Pack size
CP50912 Oct 2014 5 x 3ml
CP50750 Jul 2014 5 x 3ml
CP50639 Jul 2014 5 x 3ml
CP51706 Jan 2015 5 x 3ml
CP50940 Oct 2014 5 x 3ml
CP50928 Oct 2014 5 x 3ml
CP50903 Oct 2014 5 x 3ml
CP50914 Oct 2014 5 x 3ml
CP50640 Jul 2014 5 x 3ml
CP51095 Oct 2014 5 x 3ml
CP50904 Oct 2014 5 x 3ml
CP50650 Jul 2014 5 x 3ml
CP51098 Oct 2014 5 x 3ml
CP50915 Oct 2014 5 x 3ml
CP50412 Jul 2014 5 x 3ml
CFG0003 Sept 2014 5 x 3ml
CFG0002 Sept 2014 5 x 3ml
CFG0001 Sept 2014 5 x 3ml
CP50902 Oct 2014 5 x 3ml
CP50749 Jul 2014 5 x 3ml
CP50393 Jul 2014 5 x 3ml
CP50950 Oct 2014 5 x 3ml
CP51025 Oct 2014 5 x 3ml
CP50751 Jul 2014 5 x 3ml
CP50375 Jul 2014 5 x 3ml
CP50420 Jul 2014 5 x 3ml
CP51097 Oct 2014 5 x 3ml
CP50641 Jul 2014 5 x 3ml
CP51096 Oct 2014 5 x 3ml
CP50392 Jul 2014 5 x 3ml
Link

17/10/2013 – Class 2 Alert: Wockhardt UK Limited – Deficiencies in good manufacturing practice (GMP) in the India Manufacturing site

Following Drug Alert EL(13)A/19 a second Wockhardt manufacturing site in India has been inspected.  The inspection identified deficiencies in good manufacturing practice (GMP) and the GMP certificate for this site has also been withdrawn.

These products have been tested on importation and Qualified Person (QP) released. There is no evidence of a risk to patient safety from products currently in the UK market; however it is considered that the products have not been manufactured in line with GMP requirements.

Wockhardt UK Limited

Description Product License
Amiloride HCl 5mg Tablets PL 29831/0006
Clarithromycin 250mg Tablets PL 29831/0476
Clarithromycin 500mg Tablets PL 29831/0477
Gliclazide 80mg Tablets PL 29831/0103
Quinine Sulphate 300mg Tablets PL 29831/0182
Tamsulosin Pinexel 400mcg Capsules PL 29831/0366
Aspirin 300mg Tablets, Wockhardt & Co-op livery PL 29831/0015
Extra Pain Control Caplets, Co-op livery PL 29831/0164
Ibuprofen 200mg Caplets, Superdrug livery PL 29831/0289
Max Strength Cold & Flu Relief, Superdrug livery PL 29831/0169
Paracetamol Extra Strength Tablets, Best In, Galpharm, Happy Shopper & Spar livery PL 29831/0166
Link1 Link2

The key question we ask at bookapharmacist.com is this: Are the recent alerts a result of increasing manufacturing lapses or a result of better regulatory regime with more inspections? The former will fill us with dread and the later with hope. We hope the wave of defects in the manufacturing processes in October is just a blip.

 

Keep Calm & Stay Professional

by Kazeem Olalekan

Here is an event for the diary! On the 19th of May, the Wessex Local Practice Forum of the Royal Pharmaceutical Society has an event up its sleeves! It is an event structured to inspire Pharmacists in the Wessex region. It is being chaired by Jane Portlock, Professor of Clinical Pharmacy Education at UCL School of Pharmacy, and will involve details of the recently announced RPS Faculty.

The event is open to all pharmacists, not just members of the RPS and I hope you will be able to attend.

Spaces are limited so booking is essential. Please email lianne.denton@rpharms.com for a place.

LPF Conference

10am – 3pm

LPF_conference

 

Last Man Standing (Mr Andy Fox)

Let us put our hands together for Mr Andy Fox from Fareham. The last man standing who raised a few bob for Comic Relief on RedNose Day. And by the way…he is a pharmacist!

A funny pharmacist: Now those are two words you don’t see next to each other very often.

Will pay top dollar to watch him prepare an ’emulsion’ which looks like he ‘sneezed on it with double pneumonia’

If you can see the damage, you’ll stop!

A new ad campaign to encourage people to quit…

quit_smoking

 

 

Make quitting an important component of your New Year resolution.

 

as my friend Cyril, a smoker, said himself:

 

No good comes from smoking.

 

The question is: Wouldn’t you want to stop if you could see the damage?

Time to get the quit kit from your local chemist or online.

smoke

 Related link

 

Case Study 8: Being Cyril

by Kazeem Olalekan MRPharmS

 

cyril3

In our latest interview, Kazeem chats with Cyril Siou – Community Pharmacist. This interview effectively introduces the reader to Cyril – the man. He was one of the people that said yes when I presented him with a blank canvass of what I wanted to achieve with this project. The passion that motivated the project is alive and kicking. This interview aim to re-focus attention on quality in what really matters. The interview can be listen to here.

As is becoming customary, we have a complimentary video on YouTube as well.

 

I will not do an MUR if I felt it wasn’t going to be quality MUR and the patient is not going to gain something out of it.

 

No good comes from smoking

 

on delivering MUR:

 

I don’t really want them (the patients) to feel that this is a lecture. I want them to gain something out of it.

 

 

My Conference notes 2: What is Medicines Optimisation?

by Kazeem Olalekan MRPharmS

conference_notes
I was at the Pharmacy Management National Forum held on Thursday 15 November 2013 at Novotel  in Hammersmith. This is the second instalment of my conference notes. In my first instalment, I eluded to what we are doing in  Wessex around transfer of care. I will be using this post to explore what Medicines Optimisation really is. But before I do that, however, I will like to discuss one or two things that is imperative about the person who will deliver that Medicines Optimisation for our patient:

  • Clearly the person has to be a pharmacist working in a primary, secondary or tertiary care setting.
  • To be able to do justice to this service, that person must believe that s/he can really make a difference. In effect that person should be an Medicines Evangelist. In our parlance, we call that an MUR Evangelist.
  • As a good starting point, I like the acronym used by Dr Mark Tomlin, in our case study interview,  to describe what an Hospital Clinical Pharmacist does. If you strip that down, I honestly believe that the acronym works for any area of pharmacy practice. Different areas of practice will emphasise different areas of the acronym. The acronym is very S P E C I F I C and represents a good starting point.

S – supply chain understanding and intelligence
P – posology/product knowledge
E – in-depth understanding of errors: why they occur and how to prevent them
C – expertise in calculation and pharmacokinetics
I – medication interaction management
F – in-depth understanding of formulation of drugs
I – management of IV incompatibilities
C – pharmacology & therapeutics

What are the drivers that makes one want to make a difference in a sustainable way?

Passion for the subject is clearly important and the right mix of passion is imperative. We used a dualistic model of passion in final year and pre-registration pharmacists to describe professional engagement (and this). Without passion, I observed, we risk feeling nothing as our legs are sheared off – just like the apocryphal tale of Lord Uxbridge’s leg in the battle of Waterloo.

It is with a lot of anticipation for this Pharmacy Management Forum, that I started tweeting on the train on my way to Waterloo station from Southampton. I was not disappointed. It wasn’t just me. Check out the video below which details what those who attended thought.

One of the key presentation that grasped my attention with respect to drivers for wanting to make a difference, is the burning platform metaphor used by Clare Howard in her presentation.

Better probable death than certain death.

In the land of burning platforms, there are far too many pyromaniacs.

Keywords are: Balance, Burning Ambition, Fulfilling Leadership potential, Desire to live a big and authentic life

We got over the personal stuff: What do I understand by Medicines Optimisation?

 

Medicine Optimisation can transform lives.

It is a duty of quality.

It is about outcome, value and quality

– Keith Ridge

This may sound nebulous at first glance but it is a lot more profound. If I were to explore this in more details from the  interview given by Dr Keith Ridge to the Journal recently, the magnitude of the concept will start to filter through. The concept, according to Dr Ridge, is about improving quality, outcome and value for patients from their use of medicines. It is about higher level of engagement with patients and the public as well as breaking down barrier between professions.

Examples:

  • If a patient were to present in the pharmacy with specific problems with their medication…what are we going to do? Are we going to just send them away to their GP or are we going to own it and make representation on their behalf to the relevant health professional? There are tools like MUR and NMS we can now use to make this happen.
  • Is this just about medication? Or are we going to take a more holistic look at the patient to understand drivers relevant to the specific medication issue? I interview a colleague of my Patricia Lee, recently. She said something to me in the course of the interview that rang so true. Listen below:

When the Panel was asked if Medicines Management failed the NHS, It was argued that we need to build on the strength of medicines management and move to a position where we focus on outcomes and engage with patients. I quoted Richard Seal as saying:

Medicines Optimisation is far more patient centred.
Richard Seal

 

 Medicines Optimisation is not just about cost. It is about multidisciplinary working for patient’s benefit.

 

Dr Ridge said that Medicines Optimisation cuts across all therapeutic areas and will be working with NICE to produce a guideline. We will hold Dr Ridge up to that promise.

 

When the question was posed whether Medicine Optimisation is airy-fairy? I will let you be the judge of that. I don’t think it is. I have reached that conclusion from facts on the ground. This is not hocus pocus. It works and I think you should try it.

Case Study 7: To infinity and beyond…

by Kazeem Olalekan MRPharmS

It is with great pleasure that I introduce the subject of our most current case study. I have been busy interviewing this amazing community pharmacist.  Her name is Patricia Lee, Community Pharmacist at Tesco-in-store pharmacy at Bursledon Towers, mother to Lucas, wife to Romano, loyal, knowledgeable, experienced and all round supper community pharmacist and by God’s grace mother to a bouncing baby boy or girl this xmas.

Link to the interview here plus a complementary YouTube Video. You have to listen and watch this!

MURs are really a great way of getting to the heart of what matters for our customers who have dispensed medicines with us.

My Conference notes 1: Pharmacy Management National Forum

by Kazeem Olalekan MRPharmS

One of the cornerstones of pharmaceutical research (and indeed any other scientific research) is dissemination. If you have done the work, why would you not want people to know about it? It is with that in mind that I congratulate the Chief Pharmaceutical Officer of Hampshire and Isle of Wight LPC, Ms Sarah Billington (interviewed below by the CPPE on engaging local stakeholders with HLP)  for her quick thinking in registering a poster presentation of the successful Transfer of Care events we worked on in Wessex at a recent Pharmacy Management National Forum.

 

We work under very short deadline to deliver the poster and it offers myself a unique opportunity to attend the conference. I was pleasantly surprised at the quality and organisation of the conference. The line-up of presenters was top-notch, as they say. I made some notes and twitted my experience a bit. You will find below my range of tweets and re-tweets on the day.

 

It was a great experience for me. This is the first of the five notes I made at the conference just to give readers a glimpse of what happened and what I learned. It is also an opportunity to reflect on what I heard at the conference. For a comprehensive look at what happened at the conference, the good guys at Pharmacy Management have put together a toolkit which captures:

“….the content from over 20 satellite sessions and 79 posters can now be downloaded via this link:  http://pharmanforum-toolkit.co.uk/

Delegates and Pharmacists employed within the NHS and other Healthcare Professionals involved in Medicines Optimisation will be able to download the ‘toolkit’ for FREE.

If you need a reminder of the password please contact forum@pharman.co.uk

For all others the ‘toolkit’ will be available to purchase for £90 plus VAT.  Please contact Katie Fraser

 

Many thanks also to Jason Peett and Janet Beith for a job well done. I think we deserve a pat on the back! What we did has been disseminated! This is another opportunity to thank all those that took part in organising the events across Wessex.

 

Pharmacy: The Profession of Aspiration

by Kazeem Olalekan MRPharmS

When I talk about Pharmacy being the profession of aspiration, some of my colleagues cringe! I understand why they might. It fits into an old narrative that goes something like this: we are pharmacists because we failed in our bid to get into medical school. It is true that some people who studied pharmacy or are studying pharmacy today might have wanted to do different things but the fact is they are pharmacists now and they are getting on with the job in hand. A pharmacist does not see himself or herself as a medical doctor. Their spheres of expertise are different and can be complimentary.

Aspiration, as I see it, is not about wanting to be a medical doctor but rather to achieve greater and better things for our profession and our patients. Who was it that said: “Stand still and silently watch the world go by – and it will” ? So as a profession of aspiration, pharmacy aspires to be the de facto authority in medicines optimisation (If you are not sure what this is, I will explore it in more details in subsequent posts).

The main reason for writing this however, is to highlight the analogy I made to the Transition Committee in October 2008 in my “Case for Community Pharmacy” (The document is now available on our new ‘Documents Central page’ – where we will henceforth make documents available for public browsing and downloading).  I wrote the following:

The community pharmacist must understand its integral role in delivering quality service for the patient and enhancing the profile of the profession. The community pharmacist is the expert at interpreting complex drug issues and presenting it in a way that will be relevant to and make sense to his patient. This is no mean feat. He must not only be clinically aware but must also have the relevant ’soft skills’ that will enable him to ‘connect’ with the patient. Only an expert can carry this off. The question must therefore be how do we make sure our community pharmacists realise their expertise?

To this end, I will offer this observation: A medical student, Mr ABC went to meds school, worked very hard and passed his exams then graduated. He becomes Dr. ABC. He is very proud of becoming a doctor (with the Dr title in front of his name). He continues to work hard and specialises in surgery and at this point he drops the Dr. title and now want to be called Mr. ABC. He will chastise you if you call him doctor. The message here is that something powerful happens to the mind when it becomes recognised as an expert. It stops trying to prove to people that it is knowledgeable but now focus on applying that knowledge to the benefit of its patients. The challenge to the new professional body is to adopt strategies, which will train and recognise the community pharmacist for their expertise. It is only then that the community pharmacist will become confident.

I then concluded that:

A community pharmacist expert is of great benefit to us all. A professional body, which is widely respected across the wider society, is powerful and various healthcare decision makers will seek its viewpoint. The new Royal Pharmaceutical Society of GB must look after all its gateways to the wider society and community pharmacy is an important component of these.

What was true for the community pharmacy in my contribution 4 years ago, was true for the entire profession. You will understand therefore, that once someone or an entity is recognised as an expert in something, he/she/it/they  stops trying to prove to people that it is knowledgeable but now focus on applying that knowledge to the benefit of its patients. As in the example above, the ‘Dr’ title becomes redundant.

We (the pharmacy profession), that is myself included, will continue to strive to be the best we can be. This reminds me of a nursery rhyme, I was teaching my daughter recently:

Good, Better, Best…I will never rest, until my good is better, and my better best!

 

Now, That is aspiration for you!