Piloting a Novel Multidisciplinary Telepharmacy Medication Review Service in a Rural Community Michelle Rothwell Senior Pharmacist Atherton Hospital - CHHHS Rural Advisor to the Society of Hospital Pharmacists Australia (SHPA) Overview
• Background • Methods • Results • Conclusion
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Atherton Telepharmacy Outpatient Service
13th NRHC
3 Clinical Pharmacists
• Decrease medication misadventure • Deliver optimum medication services
4 5 6 7 Home Medication Reviews
Established to decrease medication misadventure in community Initiated by General Practitioner
8 Clinical Pharmacists
Community Liaison Hospital Outreach Model of Care
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Equitable access to a pharmacist
10 Rachel – Nurse Champion and Innovator
11 12 and and
13 14
= Novel Multidisciplinary Telepharmacy Medication Review Service
15 Month/Year Number of Telehealth consults December 2015 1 January 2016 3 February 2016 3 March 2016 1 April 2016 1 May 2016 2 June 2016 1 July 2016 1 August 2016 3 September 2016 1 October 2016 1 November 2016 5 December 2016 1 January 2017 3 February 2017 3 March 2017 3
16 Month/Year Number of Number of Number of Telehealth Medications being Interventions/ consults taken: recommendations
December 2015 1 18 9 (7 medications ceased)
January 2016 3 56 16 February 2016 3 27 13 March 2016 1 10 5 April 2016 1 13 6 May 2016 2 16 3 June 2016 1 12 4 July 2016 1 1 0 August 2016 3 22 5 September 2016 1 21 1 October 2016 1 16 6 November 2016 5 51 21 December 2016 1 9 5 January 2017 3 24 12 February 2017 3 32 9 March 2017 3 31 4
17 • 33 telepharmacy consults
• 361 medications being taken
• Average = 11 medications per patient
• 119 recommendations were made
• Average = 3.6 recommendations per patient. 18
“First time I’ve done a videoconference. The screen was clear and I liked the experience. I’d do it again”
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“This process is new to us – enjoyed skyping – amazing service”
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“I am extremely grateful for the pharmacists advice and time”
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Martin (name changed for confidentiality)
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42 years old
Wife & two teenage daughters
Klatskin cholangiocarcinoma
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Liver and peritoneal metastasis
Biliary stent in-situ
Peritoneal Drain
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Palliative care physician - 70 klms away
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Complex medication regimen
27 Discharge Medications
Inject 2 once each day via Hydromorphone (Dilaudid- Dexamethasone syringe driver (current Treat severe pain Take 1 tablet in the HP) 50mg/5mL Injection (Dexmethsone) 4mg New Prevent nausea driver dose = 120mg daily) MORNING Tablets
Inject 2 once each day via Hydromorphone (Dilaudid- Syringe driver (daily driver Treat severe pain HP) 10mg/mL Injection CLONAZEPAM (Rivotril) dose = 120mg) Inject 1mL at NIGHT when 1mgin 2 mL (set containing required (dose = 0.5mg in New Levetiracetam (APO- solution 1 mg in 1 mL and 1 Take half a tablet TWICE a 1mL) Levetiracetam) 500mg Treat epilepsy mL diluent) Injection day Tablets
Macrogol 3350 (Herron Take 1 sachet in the Treat constipation ClearLax) 17g Sachets MORNING
Pantoprazole (Somac) Take 1 tablet in the Place 1 wafer on the tongue Treat reflux disease Olanzapine (Zyprexa zydis) 40mg Tablets MORNING and allow to dissolve, once New Treat nausea 5mg Wafer each day when required Sodium Bicarbonate Use 10mL of mouthwash (Orion) 1%, 500mL Mouth Mouth care FOUR times a day wash Place half a tablet under the Lorazepam (APO- Miconazole (Resolve Tinea) Apply cream THREE times a tongue four times a day New Treat anxiety Antifungal cream Lorazepam) 1mg Tablets 2%, 25g Cream day when required.
Trimethoprim – Inject 2 THREE times a day Sulphamethoxazole Antibiotic; Prevent bacterial Hydromorphone (Dilaudid- Take 1 tablet TWICE a day when required (Bactrim DS) 160mg-800mg infection HP) 10mg/mL Injection Tablets
HYPROMELLOSE with DEXTRAN (Poly-Tears) Eye Instil 1 drop FOUR times a Dry eyes drops 3 mg-1 mg per mL day (0.3%-0.1%), 15 mL
28 Rachel – Nurse Champion and Innovator
29 30
Outcome was five more days at home
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Cost saving for hospital = $7500
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Priceless
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Allied Health Rural Generalist Trainee Programme
Allied Health Professionals Office of Queensland
34 Government funding of telepharmacy medication reviews = equity for rural patients
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