Palliative and End of Life Care – getting it right first time

Sudhir Sehrawat, Community Pharmacist and RPS Welsh Pharmacy Board member
Sudhir Sehrawat, Community Pharmacist and RPS Welsh Pharmacy Board member

by Sudhir Sehrawat, Community Pharmacist and RPS Welsh Pharmacy Board member.

 

Getting it right – first time.

 

In every day working life we strive to get things right so we achieve the results that people need. It saves time, avoids duplication of effort and you get the result you want. Yet, as a community pharmacist, I see palliative care as an area where we sometimes don’t get things right first time due to the complexity of the systems and processes involved.

 

What happens when we get it wrong

 

In a real life scenario I was presented with a prescription by a patient’s relative for end of life medication on a Saturday morning. The medication prescribed was not on the Health Board Palliative Care Formulary and the family had spent most of the previous day travelling to various community pharmacies to get the prescription dispensed. I contacted the out-of-hours GP explaining the situation and the relative was asked to attend the out-of-hours service for a new prescription. They returned after lunch with a new prescription, however, the hand written prescription did not meet the controlled drugs regulations. I contacted the out-of-hours service again and the family member was asked to pick up a new prescription and return to the pharmacy. The controlled drug was supplied in part due to limited stock held but was enough to last until Monday evening. I explained we could order the remaining stock and deliver it when it arrived. After work on Monday evening I visited the patient’s address with the remaining medication only to discover the patient had sadly, already passed away on Saturday evening.

When a patient is at end of life members of the family and friends need to be with their loved ones, not chasing supplies of medication.

There’s lots to consider within this one real life scenario.

  • Why was a non-formulary palliative care medication prescribed?
  • Why was the alternative controlled drug prescription not written correctly?
  • Where were the communication channels to let the community pharmacy know the patient had passed away?

This single case is typical and highlights multiple opportunities to improve care at the end of life.

 

Getting it right in future

 

I welcome the upcoming policy on palliative and end of life care by the Royal Pharmaceutical Society in Wales. This leading policy will address the issues we healthcare professionals face and importantly, allows patients high quality coordinated care. Patients and carers have the right to be treated with dignity and respect. The policy outlines key areas to ensure patient empowerment through timely access to medication, providing the right support through shared health care plans and offering education and training to the workforce.

If we work on an All Wales approach and implement the key recommendations of the policy, we have the opportunity to drive quality improvements as well as reduce demands on our health and social care services. I’m fully behind the policy as I hope many of you reading this blog will be. Lets get it right – first time.

 

RPS new Palliative and End of Life Care policy for Wales will be published at the end of November, and launched at the RPS Medicines Safety Conference in Cardiff on November 22. 

Palliative Care & The Pharmacy Team – what do we have to offer?

by Elizabeth Lewis, Palliative Care Pharmacist

What do we pharmacists have to offer?

I have just retired, having had a very rewarding career as a palliative care pharmacist. I firmly believe pharmacy has a key role to play in supporting patients and their families, as well as other professions, in the delivery of palliative care services in both community and secondary care. Currently we are an under used resource but have the potential to offer much more to existing services.

Community Pharmacists are ideally placed to advise on the safe and effective use of medicines. The local pharmacist is a readily accessible source of information and advice for both the patient and those supporting them. With improved communication with fellow professionals in both the community and secondary care services they would be better placed to ensure the supply of essential medication and support. This in turn would help community services in supporting patients who wish to die at home.

In secondary care the inclusion of an advanced specialist pharmacist in the palliative care multidisciplinary team is beneficial in providing advice on all aspects of medicines management from the suitability and availability of drugs and the prescribing options to the use of drugs in renal and hepatic failure. Non specialist pharmacists also have a role in ensuring symptom control is optimised, appropriate and effective.

For pharmacists to reach their full potential in the field of palliative care they need access to education and, where appropriate, the opportunity to gain experience in working with palliative care patients.

The scope of palliative care includes many non-cancer diagnoses and, with an ageing population, there are more patients requiring palliative care input than ever before. Pharmacy needs to rise to the challenge. We have made a start in Wales and have formed the All Wales Palliative Care Pharmacist Group, for pharmacists with a particular interest in palliative care.

*The group undertakes projects on a national basis such as the Just in Case Box scheme and the development of the syringe driver chart and also acts as a support group for its members.

We need to build on these foundations to ensure pharmacy provides great care for palliative care patients and continues to develop expertise in palliative care medicines use across the whole range of pharmacist roles

Elizabeth Lewis is a major contributor of expertise to our new Palliative and End of Life Care policy for Wales, which will be published at the end of November and launched at the RPS Medicines Safety Conference  in Cardiff on November 22.

A revolution for health and social care in Wales?

by Ross Gregory, Head of External Relations, Royal Pharmaceutical Society in Wales

Ross Gregory, Head of External Relations, RPS Wales
Ross Gregory, Head of External Relations, RPS Wales

If you haven’t already heard of the Parliamentary Review of Health and Social Care in Wales, there is little doubt you soon will. Published early in the New Year and anticipated as one of the most important independent advisory reports for the NHS Wales in nearly two decades, the report makes a case for change for radically transforming the Welsh model of health and social care to make it fit and sustainable for the future.

I would recommend you take a look at the report. At less than 40 pages long, it’s far from an onerous or difficult read and you may find it provides a certain ‘feel good factor’. You may even find it provides a ray of hope that the challenges facing us in the delivery of health and social care services are being thoroughly addressed. Beyond the glow of enthusiasm and optimism however, a number of critical questions remain; Will the report have the potential to drive a revolution from within our system and significantly transform services? What will a new system look and feel like? What will this mean for pharmacy services and the future of pharmacy profession in Wales?

Read more A revolution for health and social care in Wales?

Measles in South Wales – what you need to know

Jodie Williamson MRPharmS, Pharmacist at the Royal Pharmaceutical Society
Jodie Williamson MRPharmS

by Jodie Williamson MRPharmS, Pharmacist at the Royal Pharmaceutical Society

In June 2017 Public Health Wales announced that there were four confirmed cases of Measles in Newport. By July 24 the number of cases confirmed had increased to 10. This outbreak triggered a rolling vaccination programme in the area, with over 1,000 children receiving the measles-mumps-rubella (MMR) vaccine. This outbreak was caused by the same strain of measles that has affected more than 14,000 people across Europe this year, and has sadly killed 35 people to date.

So what do you need to know about measles to keep you and your family safe?

Measles is a highly infectious viral illness which is passed from person to person via droplets which are released into the air when an infected person coughs or sneezes. The virus can live on surfaces for several hours and you can catch measles just by touching that surface and then placing your hands near your nose and mouth.

The symptoms of measles are:

  • Cold-like symptoms such as sneezing and a high temperature
  • A Cough
  • Sore, red eyes which are sensitive to light
  • Small greyish-white spots on the inside of the cheeks
  • Reddish-brown blotchy rash which usually appears a couple of days after the other symptoms.

If you think that you or your child may have measles you should contact your GP. It is important to call the surgery before you attend so that they can take steps to reduce the risk of other patients becoming infected whilst you’re there. If you or your child has received two doses of the MMR vaccine or previously had measles then it is unlikely to be measles – there are a number of other conditions with similar symptoms.

 

Treating a measles infection

There is no specific treatment for measles, but there are a number of things you can do to ease the symptoms in ordinary cases.

  • Paracetamol can be used to reduce a high temperature and relieve pain.
  • Closing blinds/curtains or dimming lights can help with sensitivity to light.
  • A sore throat or a cough can be soothed with hot drinks, particularly those containing honey and lemon. It is important to note that honey should not be given to babies under 12 months old.
  • Drink plenty of fluids to avoid dehydration.
  • Wash away crustiness around the eyes with damp cotton wool.

Your local pharmacist will be able to advise you on the best treatment for your symptoms. They will also make sure that any medicines you buy over the counter are safe to take with your regular medication if you take any.

 

More serious cases of measles

Measles usually lasts for 7-10 days and although it is often unpleasant, most cases pass without any additional complications. However, some people can develop serious, and even life-threatening illnesses such as pneumonia and meningitis. Other life-changing complications can include blindness and deafness. Serious complications are more likely to develop in children under 5, children with a poor diet and people with a weakened immune system.

Warning signs of serious complications from measles to look out for include:

  • Shortness of breath
  • Sharp chest pain that is worse when breathing in
  • Coughing up blood
  • Drowsiness
  • Confusion
  • Convulsions (fits)

If you or your child develops any of these symptoms you should go to your nearest accident and emergency (A&E) department or dial 999 for an ambulance.

 

Stop your family from being affected in the first place

The best thing you can do to protect you and your family from measles if make sure that you have all had two doses of the MMR vaccine. The first dose is usually given to babies when they are between 12 and 13 months old, and the second dose is given at 3 years and 4 months, but it is never too late to get vaccinated. If you’re not sure if you have received the vaccine, contact your GP surgery who will be able to check your records.