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.

Pride in Practice : Being brave

by Dr. Claire Thompson, RPS Deputy Chief Scientist

She…

I’ve written lots of blogs on science or leadership but never about being gay, so this is my first professional outing.

I’m fortunate in that I have never experienced overt homophobia in the workplace. This is in stark contrast to my personal life, where experiences have ranged from:

– Being abandoned by groups of friends at school;
– Family members not coming to my wedding because they didn’t “agree with it”; and
– Strangers in the street shouting “You deserve to die” for simply holding hands with my girlfriend. (No, this wasn’t the 1950s, it was 2003)

Even though they haven’t been painful professional experiences, it doesn’t mean there haven’t been uncomfortable ones. Like every time someone asks “What does your husband do?”. I’ve lost count of the number of times I’ve responded “They….” or “My partner….” Because I didn’t want people to feel uncomfortable or embarrassed. But the longer you leave it, the more uncomfortable the discussion gets.

When is the right time?

So, when is the right time to say “She” or “My girlfriend” or “My wife”? Over the last few years, I’ve made a conscious decision to get “She” in early. The birth of my daughter really helped with this. As a proud parent, I would show people photographs and they would say “You look great for having a young baby” to which I could respond “Oh my wife gave birth to her, and she looks better than I do!” (See the photo below as proof). I find that openness, humour and a baby photo go a long way to diffusing any discomfort. Of course, there have been occasions where I have just taken the compliment (please don’t tell my wife)!

Dr. Claire Thompson (right) with her family

Brave

Coming out to colleagues still doesn’t come naturally, it always takes an element of bravery and I do admit that there are some people that I still don’t tell because I know they will judge me unfairly. Ultimately, we need to be comfortable with what we share about ourselves.
But if you do want people in the workplace to know that you are gay, take a deep breath and go for it.
Be brave. Be you.

Pride in Practice

by Sarah Steel MRPharmS, RPS Wales Policy and Practice Co-ordinator

Sarah Steel MRPharmS, Policy and Practice Coordinator

With August being the month we in Wales choose to celebrate Pride, what better time for the RPS Wales team to join the ongoing campaign for unity, equality, acceptance and embracement. To show our solidarity, some of our RPS staff members will be sharing their experiences in pharmacy as members of the LBGT community, and on the 24th of August, the eve of Pride Cymru, in the office we will be donning our brightest colours, eating rainbow cakes and flying the flag in support of Pride.

Why we still need to worry about equality

I’ve found myself thinking recently – if last year marked the 50th anniversary of the 1967 Sexual Offences Act and the “de-criminalisation of homosexuality”, why are members of the LGBT community still being tormented, isolated and discriminated against? It turns out, my ignorance was distorting my understanding. In 1967 homosexuality was in fact only partially de-criminalised; many anti-gay laws remained, and criminalisation did not in fact toally end in the United Kingdom until 2013. That’s only five years ago!

Five years ago, I was in my second year of University. Through my time at University and my career to date, I have been a proud member of the LGBT community. For the majority of the time, I have felt accepted and embraced, but I can’t say I have always felt that I am, or would always be, treated the same. My sexuality is something I am conscious of in interviews, when starting new jobs or working in new teams. I am still, in 2018, worried how people will react when, for example, I correct he to she when talking about my personal life. And I am sad to hear from colleagues and friends that they have had much worse experiences, including homophobic slurs and discrimination.

Join us and show your Pride in Practice

What stands out to me clearly is that LGBT rights and support is not a moot point, and there’s still a long way to go. The celebration of the campaign and the achievements so far is as important as ever, and we hope that through our blogs and  photos, we can be a part of the campaign for unity, equality, acceptance and embracement for all of our members. We’d love it for members to join us by sharing photos of your involvement this weekend, either at home or in the work place. Be sure to tag your social posts with #RPSPrideInPractice so we can share!

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?

Choose Pharmacy

Jodie Williamson MRPharms
Jodie Williamson MRPharms

by Jodie Williamson MRPharmS, Pharmacist at the Royal Pharmaceutical Society

In November 2015 the Royal College of General Practitioners (RCGP) Wales claimed that we need 400 more GPs in Wales by 2020 to avert a crisis in our NHS. We are frequently told about the crisis facing GPs. But did you know that many health problems can be resolved without the need for a GP appointment? Your local pharmacist is there to provide advice and support for a number of common complaints and in some cases, they can even provide treatment on prescription or free of charge.

There are a number of pharmacy services available across Wales. It’s worth Find your local pharmacy services, and using your pharmacy as your first point of contact for any non-emergency medical needs. Here’s a round-up of just some of the services on offer across Wales:

Choose Pharmacy

This service has been developed to help relieve pressure on GPs. It gives pharmacists access to a summary of a patient’s GP record, provided the patient gives their consent for them to view it. This improves patient safety and allows pharmacists to treat minor conditions through the Common Ailments Service (CAS). This allows you to see your pharmacist for a long list of common conditions, including hayfever and conjunctivitis, and you will receive advice and any necessary treatment free of charge. It is currently available in more than 220 pharmacies in Wales and the Welsh Government has made funding available to roll it out to all pharmacies in Wales by 2020.

Stop Smoking Services

All pharmacists are able to provide advice and support to those wishing to stop smoking, and in many pharmacies quitting aids such as nicotine patches, lozenges and chewing gum are available free of charge through the smoking cessation services available.

Triage and Treat

If you live in Carmarthenshire, Ceredigion or Pembrokeshire, or are even visiting the area on holiday, you can access the triage and treat service. It is available in a number of pharmacies across the West Wales area, offering treatment for a range of low level injuries and potentially saving you a trip to A&E or the doctor. The list of injuries that they can treat includes:
• Minor cuts and wounds
• Sprains and strains
• Eye complaints e.g. sand in the eye
• Removal of items from the skin e.g. splinters or shell fragments
• Minor burns including sunburn.
You can get advice on managing the above injuries from any pharmacy, but this service enables pharmacists to offer additional onsite treatment.

Emergency Contraception

You don’t need to see your GP for emergency contraception (often referred to as the morning after pill). It is available to buy over the counter from most pharmacies, and many pharmacists are also registered to provide it free of charge following a short consultation to make sure it is appropriate for you to take. This will be done in a private consultation room and you don’t need to tell anyone else what you are there for – just ask for a private chat with the pharmacist.
At a time when the NHS is under enormous pressure, think about visiting your local pharmacist first – if they can’t help they will be able to refer you to the best person for your needs.

2014 – a busy year for pharmacy in Wales

Jocelyn-Parkes

by Jocelyn Parkes, Director, Royal Pharmaceutical Society in Wales

Hello, I would like to introduce myself as the new Director of the RPS in Wales. Some of you will know me already as I have been working as Principal Policy Advisor at the RPS for the last ten years. For the past few weeks, whilst the rain has whipped itself against the windows of the RPS Wales office, the Welsh Pharmacy Board and RPS Wales’s staff have been busy planning the work programme for the coming year and how, through our work, we can best support you as members.

In this first blog post of the year, I would like to share with you our plans for 2014. As for future blogs, I would be interested to hear your views. What topics and authors you would like to be covered in future blogs? Please email our Communications Officer, Kirsty.luff@rpharms.com  with any ideas, or record your views publicly below.

Read more 2014 – a busy year for pharmacy in Wales

Co-operation, not competition is key to patient safety

By Paul Myres, Chair of the Royal College of General Practitioners in Wales

They may be different professions working in different places on the high street but there is one thing that unites GPs and pharmacists: a belief that patients in Wales are put at risk by failures in communication and understanding between health professionals – failures arising from outmoded systems and silo thinking. Read more Co-operation, not competition is key to patient safety