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Improving Inhaler
Technique through
Community
Pharmacy Service
Greater Manchester
Area Team
Autumn 2014
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Service
Specification
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Service Details
• 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
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Inhaler Technique Patient Pathway Flow Chart 1
Step One Patient on inhaled
medication and meets the standard
requirements for a MUR.
Step Two Patient asked the
complete the ACT/CAT assessment.
Is the score ≥ 20 for ACT or ≤ 10 for
CAT?
Yes
Patient
demonstrating good
control, but may have
poor technique. See
flow chart 2
No
Step Three Patient invited to
participate in inhaler training
Patient not had full MUR in last 12 months
Prescription Intervention undertaken
on inhaled medications only- claim
via FP34c
6-8 weeks later
Brief intervention follow up checkclaim via PharmOutcomes
Full MUR within 12 months- claim
via FP34c
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Patient had full MUR in last 12 months
Prescription Intervention undertaken
on inhaled medications only- claim
via FP34c
6-8 weeks later
Brief intervention follow up checkclaim via PharmOutcomes
Inhaler Technique Patient Pathway Flow Chart 2
Patient has an ACT/CAT score ≥ 20
for ACT or ≤ 10 for CAT?
Inspiration rate checked using InCheck® device
In-correct inspiration rate
demonstrated
Correct inspiration rate
demonstrated
Does the patient
meet the standard
requirements for an
MUR?
Follow Flow Chart 1
from Step Three
Yes
Perform MUR- claim
via FP34c
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No
Patient to be invited back
for an MUR when meets
national eligibility criteria
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
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Premises Requirements
•
•
•
•
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
http://www.england.nhs.uk/pharm-adv-serv/
• Signed SLA submitted to AT
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Pharmacist
Accreditation
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Pharmacist requirements
• 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
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Declaration of Competence
• 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
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Top Tips
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Top Tips for Respiratory MURs
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.
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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?
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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?
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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
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Questions?
agm.optometrypharmacy@nhs.net
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