2020 Another game changer for Pharmacy in D&G by Graeme Bryson

“Pharmacy has seen a lot of change over the last few years both locally and nationally

In 2017 the national pharmacy strategy for Scotland was launched with its key focus of improving the safe use of medicines across the country

 

You may not be aware be but there are three ‘sectors’ in which pharmacy operates in NHS in Scotland.

Community pharmacy and hospital pharmacy practice have been considered the core pharmaceutical care services.

But we have seen a significant development within primary care pharmacy services from a prescribing advisory service to a clinical service working in an integrated way with General Practice.

This has been possible through the Primary Care Transformation Agenda and is known as the Pharmacotherapy Service.

So what is happening in pharmacy across the sectors in Dumfries & Galloway

Pharmacotherapy Service

Locally we are shaping the direction of travel for this new service through our innovative models of service provision.

The main ones to note are the pharmacotherapy hubs and our pharmacy technician development program.

We were also one of the first areas to bring in a pharmacy support worker in primary care.

Moving forward into 2021 our pharmacotherapy service has to look to enhance the clinical function of pharmacists (both in the community pharmacy & GP practices) and keep making better use of our skill mix with technicians and support workers.

2019 Scottish pharmacy award for Wigtonshire Locality (one was also won in 2018)

 

 

NHS Pharmacy First – New community Pharmacy consultation Service

Just this week CPS (community pharmacy Scotland) held the first local road show with local community pharmacists to introduce the new NHS Pharmacy consultation service.

This service is being launched later in 2020 all across Scotland.

It is viewed with some envy across the UK and across the world as it is said to bring the A.R.T to community pharmacy practice (A= Assessment R=Referral T=Treatment)!

CPS CEO Harry McQuillan talking to NHS D&G community pharmacy teams at recent roadshow

Hospital Pharmacy Transformation

Hospital pharmacy in D&G has a strong foundation with the advanced technology within the acute services.

As well as already having HEPMA (Hospital Electronic Prescribing and Medicines Administration) established & functioning in clinical acute care areas, we have cutting edge technology in the department in the our Aseptic production suite and department robots.

At the end of 2019 the team completed a series of hospital pharmacy transformation development sessions to assess progress and determine what developments our services can drive to support the challenges within Acute care in NHS D&G

A view inside ‘Victor’ one of the DGRI pharmacy robots (the other is called ‘Jack’)

 

 

Pharmacy manages this off the backdrop of challenges in recruitment –which is not unusual in todays NHS – and the pace of chance & expectations can sometimes be very challenging.

As Director of pharmacy I think it is vital that we keep investing in the development of all people in pharmacy services to keep our teams working with confidence as well as capability.

To finish – I’d like to end by taking the opportunity to to say ‘Thank you’ to all pharmacy team members in all three sectors working hard to make the use of medicines safe & effective across D&G

Graeme Bryson is Director of Pharmacy at NHS Dumfries and Galloway

 

 

It’s not about the cup of tea … One lump or two dear by Emma Miskimmins

Occupational therapy (OT) is one of the most misunderstood and underutilised professions within health and social care (Dressel 2016). The reason for this is because the skills OT’s hold are largely hidden or “non-visible” e.g. the underpinning knowledge, theories and reasoning behind the profession (Turner and Alsop 2015).

One definition is “An occupational therapists job role is to help people of all ages overcome the effects of disability caused by illness, ageing or accident so that they can carry out everyday tasks or occupations.

An occupational therapist will consider all of the patient’s needs – physical, psychological, social and environmental. This support can make a real difference giving people a renewed sense of purpose, opening up new horizons, and changing the way they feel about the future” (RCOT 2020)

Often, patients will be asked by OT to complete a kitchen assessment – for example to make a cup of tea. This assessment is generally very misunderstood (Laver-Fawcett 2007) –

It is NOT about the cup of tea.

Throughout my 2 short years as an OT, it became apparent rather quickly that kitchen assessments can be perceived as the “last hurdle” in getting home or as patronising. I wanted to write this blog in an attempt to diminish these pre conceived perceptions and help to highlight exactly how important this type of assessment is with regards to the occupational therapy process and ultimately a safe discharge (Crennan and McRae 2010). Below is a simplified example of the OT process, here we can see assessment comes right after the point of referral and information gathering. This is where a kitchen assessment would be carried out – certainly NOT as the “last hurdle”.

The amount of information that can be obtained by observing someone making themselves a cup of tea is vast and includes but is not limited to…

Physical ability – does the person have sufficient stamina to stand or do they need to sit, mobilising safely around the kitchen, fine and gross motor skills, can they physically see well enough to complete the task etc…

Cognitive ability – does the person have the ability to initiate the task, do they have sufficient safety awareness, ability to sequence tasks appropriately, identifying objects correctly, memory (short and long term) etc …

Psychological factors – mood, motivation (e.g. to be independent, to participate in the task etc) there can also be motivation to ‘fail’ a kitchen assessment e.g. if someone does not wish to return home or feels care is required – this can often stem for example from loneliness. Other factors may include – anxiety, thoughts regarding own ability to manage at home (particularly if living alone) etc.

Another example of a psychological factor being loss of role. There is sometimes a fear that an OT kitchen assessment will ultimately prove a person is unable to safely function within this environment safely. This can lead to loss of role in many aspects and again can be a contributing factor to refusing a kitchen assessment (which can impact upon discharge planning immensely). Furthermore, loss of role in one aspect of life can have the domino effect and mean a person is much more likely to give up on other meaningful occupations in life; this can have a vast impact upon mental health and quality of life (Gallagher et al. 2015).

This is why it is so important to highlight occupational therapy is very much about ENABLING and INDEPENDENCE. It would only ever be recommended someone is not safe to function within their kitchen if absolutely necessary and if this was paramount to the person’s safety and wellbeing.

Environmental factors – is the physical environment enabling, or does it require adapted to suit a persons’ ability. If it is not suitable and cannot be adapted, does the person require support at home e.g. short term rehab or a care package.

It is very much taken into consideration that the OT kitchen within DGRI is an unfamiliar environment to patients. For this reason, in some instances it may be more appropriate to have the person assessed within their own home environment. This may happen if a person has visual problems where they are used to a particular set up. However, more often than not, the kitchen can be set up similarly to that of a patient’s home and the assessment can be completed within the OT kitchen prior to discharge.

Perceptual factors – spatial awareness, being able to differentiate between surfaces, proprioception, depth perception, sensory processing etc…

All of the above factors help to create a picture of how a person will manage in a variety of daily situations. This can assist with OT assessment to the extent that a decision can be made with regards to a person’s safety to return home or not.

(Baum et al. 2015).

Above is an example of the person, environment occupation and performance model. It helps to highlight how each of the factors previously mentioned interlink. No one factor stands alone and by completing a kitchen assessment not only can we gain an understanding of if a person will manage certain tasks or indeed not, but we can gain an understanding as to WHY. This is exceptionally important when it comes to treatment planning and intervention and is exactly the reason why OT’s are able to create a treatment plan with the person that is specific to that person. For example, the treatment plan for someone post stroke suffering from perceptual issues would be very different to that of someone struggling with their stamina due to a long term condition such as COPD.

So … it’s not about the cup of tea… but you’re welcome to drink it if you want.

Emma Miskimmins is an Occupational Therapist at Dumfries and Galloway Royal Infirmary

References

Baum, C. M., Christiansen, C. H., & Bass, J. D. (2015). The Person-Environment-Occupation- Performance (PEOP) model. In C. H. Christiansen, C. M. Baum, & J. D. Bass (Eds.), Occupational therapy: Performance, participation, and well-being. 4^th Edition [ebook]. Thorofare, NJ: SLACK Incorporated. Available at: https://ottheory.com/therapy-model/person-environment-occupation-performance-model-peop [Accessed 12 Dec. 2019].

Crenan, M. and MacRae, A. (2010). Occupational Therapy Discharge Assessment of Elderly Patients from Acute care Hospitals. Physical and Occupational Therapy in Geriatrics, [online] Volume 28(1), p.33-43. Available at: 10.3109/02703180903381060 [Accessed 20 Dec. 2019].

Dressel, R. (2016). OT: The Misunderstood Therapy. Provider, [online]. Available at: http://www.providermagazine.com/archives/2016_Archives/Pages/0216/OT-The-Misunderstood-Therapy.aspx [Accessed 23 Dec. 2019].

Gallagher, M., Muldoon, O. and Pettigrew, J. (2015). An Integrative Review of Social and Occupational factors Influencing Health and Wellbeing. Fronteirs in Psychology, [online] Volume 6(1281), p. 1-11. Available at: 10.3389/fpsyg.2015.01281 [Accessed 23 Dec. 2019].

Laver-Fawcett, A. (2007). Principles of assessment and outcome measurement for occupational therapists and physiotherapy and physiotherapists: Theory, skills and application. 1^st Edition [ebook]. North Yorkshire: John Wiley and Sons. Available at: https://books.google.co.uk/books?id=JdpSiGsYaaoC&lpg=PA1984&vq=the%20complexity%20of%20making%20a%20cup%20of%20tea%20occupational%20therapy&dq=the%20complexity%20of%20making%20a%20cup%20of%20tea%20occupational%20therapy&pg=PA1920#v=snippet&q=the%20complexity%20of%20making%20a%20cup%20of%20tea%20occupational%20therapy&f=false [Accessed 12 Dec. 2019].

Royal College of Occupational Therapists. (2020). What is Occupational Therapy [online]. Available at: https://www.rcot.co.uk/about-occupational-therapy/what-is-occupational-therapy [Accessed 6 Feb. 2020].

Turner, A. and Alsop, A. (2015). Unique Core Skills: Exploring Occupational Therapists’ Hidden Assets. British Journal of Occupational Therapy [online] Volume 78(12), p. 739-749. Available at: https://doi.org/10.1177/0308022615601443 [Accessed 20 Dec. 2019].

 

What we resist persists……by Emily Kennedy

 

As a pharmacist I have dished out more than my fair share of analgesics, or the other common misnomer given to them: ‘painkillers’. They rarely ‘kill’ chronic pain and in fact, most people with chronic pain will tell you that they don’t touch the pain. The inappropriate use of opiates in chronic pain has also been receiving its fair share of attention in the media of late and we know the dangers such as addiction which are linked to opiate use and other analgesics.

These are amongst the many motivating factors that led me to train as a mindfulness teacher 4 years ago, after attending a mindfulness course myself and then developing a daily mindfulness practice. I then started to deliver mindfulness courses specifically for those experiencing chronic pain in Dumfries and Nithsdale, along with Tina Gibson, an enthusiastic proponent of mindfulness in our locality. We use a well respected text, Mindfulness for Health by Vidyamala Burch and Danny Penman and follow the 8 week course described in the book along with the accompanying meditations (either on the CD which comes with the book or online, at http://www.breathworks-mindfulness.org.uk. The course offers a credible alternative for those experiencing chronic pain and can be hugely beneficial.

What is mindfulness? It is simply being aware of the present moment – being aware and noticing your breath and what is going on around you in the present. It is based on a regular practise of meditation which allows you to reconnect with the body and breath and allows you to notice and observe your thoughts as they arise without getting enmeshed and entangled in them. Imagery is often used in mindfulness and it can be helpful to imagine the thoughts as clouds floating by or as leaves dancing down a stream of flowing water. Practising mindfulness can create a more peaceful, harmonious and relaxed mind as well as improved concentration and awareness.

“Mindfulness meditation, especially when it is understood as being a way of living life as if it really mattered moment by moment, rather than merely as a technique….is one powerful vehicle for realising such transformative and healing possibilities.” Jon Kabat-Zinn

There is a growing evidence base for mindfulness applied to many therapeutic settings. When looking at mindfulness in chronic pain, brain imaging studies have illustrated how the mechanisms of mindfulness-related pain relief soothes the brain patterns underlying pain, even after brief training such as a four day mindfulness-based intervention (15 subjects, Zeidan 2011). A study of a group of 28 patients found improved mental health and perceived control over their pain compared to a control group, but that the sensory pain experience was not diminished (Brown and Jones 2013). This demonstrates that mindfulness practice is helping individuals with chronic pain to develop acceptance of what is happening for them at particular moments in time and turn towards them rather than react against the sensations. In other words, it is turning the volume control on pain down.

I have now had the privilege and honour to spend time with 9 groups of people (100 people in total) who have embarked on a Mindfulness journey in order to employ a different approach to managing their pain. Their experiences have varied enormously but all participants have agreed that they have benefited in some way – whether that is from being able to perceive their pain in a different way and manage it better, turning the volume down on the pain, coping better with day to day situations, or from meeting others in a similar situation and gaining friends and a support network – the results have been an immensely rewarding part of my job. Anecdotally participants have often been able to reduce their analgesic load without any detrimental effect to their pain and in most cases they feel a lot better for this.

We teach people to let go, rather than hang on to feelings and emotions associated with the pain which often cause more pain – the anger and frustration of what they used to be able to do or want to be able to do – acceptance is a large part of the mindfulness journey. Encouraging participants to be kind to themselves is also a key element of the course and one that can be tricky for many. Indeed, learning the benefits of kindness to myself and others has been one of the greatest things that I have learned throughout my mindfulness journey.

I think that this quote from a recent participant sums it up nicely: ‘I feel less stressed, I feel lighter, I feel happier, I feel like I can cope better’. That’s what gives me job satisfaction, knowing that I have made a difference to someone and their pain and suffering and that makes me happy!

If you are interested in investigating mindfulness further for either your own personal development or for your patients, please don’t hesitate to contact me. You may find this YouTube clip a good summary too: https://youtu.be/w6T02g5hnT4

“You can’t stop the waves, but you can learn to surf” Jon Kabat-Zinn

 

References:

Burch, V and Penman,D. (2013) Mindfulness for Health  – a practical guide to relieving pain, reducing stress and restoring wellbeing. Piatkus, London.

Brown, C and Jones, A. (2013) Psycho-biological correlates of Improved mental health in patients with musculoskeletal pain after a mindfulness-based pain management program. Clinical Journal of Pain, 29 (3):233-44

Zeidan, F et al. (2011) Brain mechanisms supporting the modulation of pain by mindfulness meditation. J of Neuroscience, 31 (14): 5540 – 48.

Emily Kennedy is Lead Locality Pharmacist, Prescribing Support, for Dumfries and Upper Nithsdale.