Improving Inhaler Technique through Community Pharmacy Service Greater Manchester Area Team Autumn 2014

Service Specification

Built upon the MUR/Prescription Intervention advance service Any patient eligible for a Prescription Intervention can be invited to join the scheme Patients newly prescribed an inhaler should receive inhaler technique training via NMS- outside of this project Patients entitled to one PI; one brief intervention; and one MUR in a 12 month period Service Details

Required data and patient consent to be captured on consultation form(s) Information to be entered on to PharmOutcomes Consultation form(s) to be retained in the pharmacy; copy to be sent to patients GP Payment for PI to be claimed via FP34c (£28) Payment for brief intervention generated via PharmOutcomes (£10) Expressions of Interest to provide the scheme to be circulated to contractors shortly Service Details

PREM1 to be submitted to AT (if not previously done) Intervention to take place in the consultation room Telephone interventions are not allowed Offsite consultations are permitted, apply to the AT via the standard NHS England procedure Signed SLA submitted to AT Premises Requirements

Pharmacist Accreditation

Accredited to undertake MURs Undergone face to face inhaler technique training since 2011 Completed the Declaration of Competence for Improving Inhaler Technique through Community Pharmacy Pharmacist requirements

Soon to be launched Pharmacists that have undergone face to face inhaler technique training are able to start and accredit retrospectively Contractors to be informed when DoC available, pharmacists providing the service will have 2 months after launch to complete Copy of DoC to be kept in the pharmacy Declaration of Competence

Top Tips

1.Check the patient’s PMR for frequency of ordering of medication before starting the review. For patients with asthma Ordering more than twelve short-acting reliever inhalers over the last year may indicate poor control and that preventative treatments need to be stepped up. Generally patients with asthma should require thirteen inhaled corticosteroid (ICS) preventer inhalers per year (might be less for 200 dose metered dose inhalers). Is the patient prescribed a long-acting beta 2 agonist (LABA) without an ICS? This requires a review of the regimen. Top Tips for Respiratory MURs

2.What does the patient know about their condition and its treatment? 3.Has the patient had a review before? Who did the review? Does the patient see anyone else for their condition? Explain that the reviews are being done with the knowledge of GP practices in the area and that the aim is to improve medicines use for respiratory conditions. 4.Check adherence with the information from the PMR and document any reasons for non-adherence e.g. difficulty in using device, side-effects, perception of ineffectiveness, lack of knowledge of indications for different inhalers. Does the patient experience any problems taking / using their medicines? Top Tips for Respiratory MURs

5.Assess inhaler technique - use In-check device. Would the patient benefit from a device switch, adding a spacer? Does the patient have the same devices i.e. MDI or Turbohaler? 6.Does the patient know how to take other medicines prescribed for their respiratory condition e.g. rescue packs of corticosteroids / antibiotics, mucolytics or theophylline for COPD. 7.Give smoking cessation advice if appropriate. 8.Does the patient need flu or Pneumococcal vaccination? Top Tips for Respiratory MURs

9.Does the patient have any questions / need more information about their medicines? 10.Refer patients if they report: An increase in exacerbations Their symptoms are not controlled Side-effects of medicines Severe or life-threatening asthma exacerbation Haemoptysis- spitting or coughing up blood Top Tips for Respiratory MURs

Questions? agm.optometry-