1. The ‘5C’ Walk-In Clinic:
Assessment & treatment of common clinical conditions in the community pharmacy setting
Jonathan Burton, Community Pharmacist, Stirling
Introduction
Early Findings
The 5C Clinic
Community Pharmacy Common Clinical Conditions Clinic
After completion of IP training and NES core clinical skills and common clinical conditions training, funding was granted by NHS Forth Valley to support an enhanced MAS / common clinical conditions walk-in service run by a PIP at Right Medicine Pharmacy, University of Stirling. ENT and dermatology were the main clinical areas for extended assessment & treatment.
Over the initial 12 month period (Sept 2016 to August 2017) a total of 349 consultations were recorded, including follow up consultations. All were ‘in hours’ consultations, 9am-5pm Mon-Fri.
Sore throat assessment was the most common type of consultation, followed by ear examination and then dermatology consultations. Eye presentations and chest / respiratory complaints formed the bulk of other consultation types and had higher referral rates.
ECS Access, a new development
In February 2017 the PIP had access granted to use the Electronic Care Summary.
In the period Feb 17 to Aug 17 the ECS was accessed 13 times to assist with gathering medical history details for patients accessing the 5C clinic service. This was 60% of the total ECS access for the pharmacist at this site.
Aims of Pilot Study
To assess the following aspects of running an extended walk-in service through a community pharmacy:
Number of consultations & patient demographics
Types of consultations (by presentation)
Effect on workflow
Outcomes (prescribing, advice, referral, patient views)
In a more general sense the first few months of providing the service would also give the PIP a chance to apply newly acquired prescribing & clinical skills and test new ways of working in terms of consultation skills, using clinical guidelines and interactions with / referrals to colleagues in general practice.
Conclusions
Many Positives:
Very accessible service, building naturally on MAS
Patients appreciate the service & are open to consultation with & examination by PIP
Structured training pathway available via IP and NES clinical skills courses
Encourages evidence based practice, use of clinical guidelines & formularies
Has helped embed chaperone policy
Areas for consideration & improvement:
Can be very intensive & time consuming consultations, workflow difficulties occasionally
Need for formal peer review (& revalidation?) network to help maintain & improve clinical & prescribing skills
More access to digital health records & inter-professional communication tools vital
Points of interest…
Text alerts were an effective way of encouraging attendance at planned follow ups (e.g. 70% of patients with planned follow up for ear problems attended on the correct day).
We introduced a new MCA protocol for sore throat presentations so only more severe cases were referred to the PIP for full assessment.
Less than 5% of sore throat presentations had a PIP written oral antibiotic prescription as an outcome. No oral antibiotic prescriptions were written for Otitis Media or Externa.
A total of 29 ‘formal’ written SBAR communications were sent to GP practices that related to 5C clinic presentations.
Dermatology presentations included eczema, infected eczema, urticaria, scabies, fungal infections & bacterial infections (incl. cellulitis).
Record Keeping & Data Collection
For each main presentation group (throat, ear, dermatology, eye & chest) a clinic consultation record form was designed for gathering of patient details & contact information, medical history, vital signs, symptoms & observations during examination. Date, time & length of consultation were also noted. A universal ‘outcomes’ record form was also completed for each consultation which detailed:
Working diagnosis
Worsening statement / referral detail
Medication prescribed & self-care advice given
Plans for Follow up
Notes on actual follow up encounters
Contact Details: