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NHS Lanarkshire Smoking Cessation Pharmacy Improvement Project: Pharmacy Guidance Pack Online Version Only

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NHS Lanarkshire Smoking Cessation Pharmacy Improvement Project: Pharmacy Guidance Pack Online Version Only NHS Lanarkshire Smoking Cessation Pharmacy Improvement Project: Pharmacy Guidance Pack Online Version Only 1 Online Version Only - PIP Visit Packs 2020-2021 Updated: January 2020 Review: January 2021 Contents Page: 1. Support Letter from George Lindsay, Chief Pharmacist, Page 3 NHS Lanarkshire 2. Pharmacy Improvement Project Contact Details Page 4 3. Smoking Cessation Service Specification August 2017 – Key Changes Page 5 4. Pharmacy Care Record System Page 8 a. PCR Hints and Tips b. PCR Screen Shot Guide c. PCR Data Recording Flow Chart 5. Cycle of Change Page 17 6. Motivational Interviewing and Behaviour Change Page 18 7. Carbon Monoxide (CO) Monitoring Page 19 8. Useful Forms and Information Page 20 a. Resources Order Form i.e. mouthpieces etc. b. Follow up request to NHS Lanarkshire c. 4 week & 12 week certificates d. Smoking in Pregnancy e. Medicines Q&A’s: What are the clinically significant drug interactions with cigarette smoking? 9. NHS Lanarkshire Varenicline PGD Information: Page 30 a. Appendix 1: NHS Lanarkshire Varenicline PGD (Community Pharmacists) b. Appendix 2: NHS Lanarkshire Varenicline PGD Risk Assessment Form c. Appendix 3: NHS Lanarkshire Varenicline PGD GP Notification Letter d. Appendix 4: NHS Lanarkshire Varenicline PGD GP Referral Letter 2 Online Version Only - PIP Visit Packs 2020-2021 Updated: January 2020 Review: January 2021 1. Support Letter from George Lindsay, Chief Pharmacist TO ALL COMMUNITY PHARMACISTS IN NHS LANARKSHIRE PLEASE SHARE WITH ALL LOCUMS AND SUPPORT STAFF AS APPROPRIATE SMOKING CESSATION SUPPORT As you know smoking cessation is a very important service and the community pharmacy contributes significantly to the health board and national targets for smoking cessation. We are constantly learning and seeking to improve on the services delivered and achieve this through our Community Pharmacy Smoking Cessation Improvement programme. This initiative has the backing of myself and Community Pharmacy Lanarkshire and has very experienced and able community pharmacists such as Heather Donaldson (Boots), Nicola Cairns (Lloyds), Alex Thurlow (independents) and Victoria Radford (Community Pharmacy Lanarkshire) involved. The purpose of this letter is to let all community pharmacies know that support from the Pharmacy Improvement Project (PIP) Team is available. This is over and above the visits from Pharmacy Champions which cover smoking cessation but a range of other issues. Should you want to contact the team on a proactive basis details are: [email protected] 01698 201 427 Pharmacy visits to localities and community pharmacies are scheduled to build a rapport and offer support and training. You will be contacted by telephone to explain a little around the support being offered and to arrange a suitable time to visit the pharmacy. The PIP team is sensitive to the urgency of work ongoing within community pharmacies. If there is a desire for a more in-depth follow up visit this can be arranged for a mutually convenient time. I hope you will welcome a member of the PIP team when they arrange visits and I will make sure that this e-mail reminding everyone of the context is sent to all pharmacies in the localities they intends to visit a few days beforehand. Regards George Lindsay, Chief Pharmacist, Primary Care NHS Lanarkshire Headquarters Kirklands Hospital, Fallside Road Bothwell G71 8BB Tel 01698 858128 Fax 01698 858271 3 Online Version Only - PIP Visit Packs 2020-2021 Updated: January 2020 Review: January 2021 2. Pharmacy Improvement Project Contact Details Pharmacy Improvement Project 14 Beckford Street, Hamilton ML3 0TA Office: 01698 201427 [email protected] Ciaran Bennett – Higher Clerical Officer [email protected] 01698 201 427 Heather Donaldson – Pharmacy Champion NHS Lanarkshire (Boots Pharmacist) [email protected] 07958 615 667 Claire McCririck– Project Manager [email protected] 01698 201 427 Contact details for NHS Lanarkshire Specialist, Mental Health and Pregnancy Services (Clients can be passed to the services below if they have had 3 or more previous quit attempts or if Pharmacist believes they would benefit from the Specialist support). Contact Locality/Area Email address Number Bellshill Motherwell 01698 366 979 [email protected] Wishaw Airdrie Coatbridge 01236 707 714 [email protected] North East Kilbride Hamilton Cambuslang 01698 723 233 [email protected] Rutherglen Clydesdale Pregnancy 07811 840 351 [email protected] Mental 01698 456 219 [email protected] Health 4 Online Version Only - PIP Visit Packs 2020-2021 Updated: January 2020 Review: January 2021 3. Smoking Cessation Service Specification August 2017 – Key Changes The Community Pharmacy Smoking Cessation Service forms part of the Public Health Service portion of the Pharmacy Contract. In August 2017, Scottish Government issued a Revised National Service Specification advising of changes to the service. Key Changes In Lanarkshire, the formulary has been updated so that Varenicline and Nicotinell patches are now JOINT FIRST LINE. The Varenicline PGD for Lanarkshire was updated in November 2018 and can be found on the NHS Lanarkshire Community Pharmacy website here:- https://www.communitypharmacy.scot.nhs.uk/media/1611/community-pharmacy-pgd-for- varenicline-nov-2018.pdf or https://www.communitypharmacy.scot.nhs.uk/nhs-boards/nhs- lanarkshire/stop-smoking-service/ Varenicline has had the black triangle removed as a result of the findings in the EAGLES trial, and as a result the references to this drug have been updated, as have some of the associated forms. The updated Varenicline Clinical Risk assessment form and GP letter template can be found as Appendices C&D. Please make sure you are using the most up to date versions! Most notably, if a client has a history of psychiatric illness, the default is no longer to refer to the GP. Instead, the pharmacist should refer to the PGD and if appropriate can commence treatment, monitoring the client closely. The NES training module on Varenicline has now been revised and pharmacists are expected to undertake the updated training which is available on TURAS. Pharmacists must have completed this training and returned the signed PGD form before they can prescribe under the revised PGD. SERVICE OUTLINE AND PRACTICE REMINDERS The service should be delivered from premises that can provide an acceptable level of confidentiality such as a consultation room The service is available to any person aged 12 or over. Consent of a parent or legal guardian is required if the person is under 13 years of age The person must be registered with a GP in Scotland The service must be available throughout standard opening hours All pharmacists and support staff who deliver the service must be trained to nationally recognised standards. This can be either the NES training available online or face to face training offered by your Health Board The service can be publicised using materials made available by Scottish Government, NHS Boards, NHS Health Scotland or relevant pharmaceutical companies 5 Online Version Only - PIP Visit Packs 2020-2021 Updated: January 2020 Review: January 2021 Data about service activity and outcomes is recorded via the PCR. MDS data are electronically submitted from PCR to the National Smoking Cessation Database. Data is uploaded from the PCR to ISD once a week overnight from Wednesday to Thursday so it is really important that all your data is added to the PCR by close of play on a Wednesday. We should PROACTIVELY seek out individuals who would benefit from the service within the pharmacy e.g. patients with cardiac or respiratory disease, pregnant women, young people and lower socio-economic groups, in other words, from the most deprived areas. What are you doing to drive this? On the first visit to the pharmacy, the client should be asked to set a provisional quit date (not entered on PCR at this stage) and return to receive their first supply of pharmacotherapy. The return date is flexible, and can be anything from a day to over a week later from the initial contact. Assessing readiness to quit is subject to professional judgement. In exceptional circumstances, we may decide to start the quit attempt on the first visit, if the client is sufficiently prepared with their own planning to be able to commence straight away. Indeed there are some groups we would always want to start straight away e.g. pregnant women, patients who have been started on pharmacotherapy in hospital, patients referred by their GP. PCR GUIDANCE The quit date should NOT be set on the PCR until the client returns for their Week 1 visit (including selection and prescribing of pharmacotherapy). Also, please be aware that the Quit Date refers to the date the patient STARTS the quit attempt, not the end of the 12 week programme Submitting the quit date on the PCR triggers the first payment of £30 Every client for whom a quit date is set on the PCR should have their 4-week MDS data submitted via the PCR, regardless of whether they are still attending. This will trigger the second payment of £15 Every client who is recorded as smoke-free and thus still on the service at 4 weeks should have their 12-week MDS data submitted – again regardless of whether they have continued to be successful with their quit attempt. This triggers the third service payment of £35 If the client is lost to follow up after 4 weeks, we should continue to attempt contact up to Week 6 and record this on the PCR and submit the 4 week MDS as Lost To Follow Up.• If they are lost to follow up at 12 weeks, we should then submit the 12 Week MDS as Lost To Follow Up Once a quit attempt has ended (successfully or not) and the appropriate MDS submissions have been made at the appropriate times, the quit attempt must be closed on the PCR.
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