Community Pharmacy Multidisciplinary Audit 2016/2017 Supporting Patients with Glaucoma Jason Carroll Medicines Management Pharmacist
Introduction As a requirement of the Contractual Framework, Community Pharmacies are required to participate in a clinical audit programme which includes at least one pharmacy based audit and one multidisciplinary audit agreed by the Local Health Board in each financial year. The attached audit is for the year 2016/17. In order that the results from all pharmacies can be analysed together, Powys LHB is requesting that all data is submitted to the LHB by Thursday 30 th April 2017. Each pharmacy is required to conduct the initial audit over a 4 week period and gather data from a maximum of 30 individual patients. Completed forms should be returned to the LHB at the address below: Medicines Management Dept Powys Teaching Health Board Basil Webb Bronllys Hospital Brecon Powys LD3 0LU Background The term glaucoma refers to a group of eye diseases that cause progressive damage to the optic nerve and in which raised intra-ocular pressure (IOP) is a modifiable factor. Ocular hypertension affects 3-5% of people over 40 in the UK, but appropriate monitoring and treatment can reduce IOP and reduce the risk of progression to glaucoma. Without treatment, glaucoma will develop over time, although the rate of progression varies. Patients may be asymptomatic until the optic nerve has been severely damaged when visual defects will present, often as peripheral vision loss initially. Further damage will occur in untreated glaucoma and any vision lost cannot be restored. Approximately 10% of UK blindness registrations are the result of glaucoma. Drugs used to treat glaucoma aim to reduce IOP to normal levels by reducing the production of aqueous fluid within the eye, or by increasing its flow out of the eye. The most common treatments are summarised below:
Class (topical preps only) Prostaglandin Analogues Prostamides Beta Blockers Sympathomimetics (Alpha agonists) Carbonic Anyhydrase Inhibitors Miotics Mode of Action aqueous aqueous aqueous Examples Latanoprost, travoprost, tafluprost Bimatoprost Betaxolol, carteolol, levobunolol, timolol Brimonidine Brinzolamide, dorzolamide Pilocarpine Products containing combinations of drugs from different classes are available and are useful in supporting patient adherence, Treatment with eye drops is usually lifelong and appropriate use is important if patients sight is to be preserved. According to literature, the rate of non-adherence in glaucoma varies between 5% and 80%, depending upon the definitions and measures used. Approximately 15% of patients may be unintentionally non-adherent, using medication at the correct times, but without applying the drops correctly 1. Educating patients on correct eye drop technique is therefore likely to have a positive impact on adherence and the avoidance of further sight loss. A guide for patients and healthcare professionals on using eye drops correctly is available on the website of the International Glaucoma Association 2. Note that patients needing to use a second preparation should wait at least 5 minutes after applying the first drop to prevent it being washed out. A range of compliance aids are available for patients that experience difficulties using eye drops. The International Glaucoma Association has provided a selection of demonstration aids which are enclosed with this audit. Further information is available in the IGA leaflet Eye Drops and Dispensing Aids which is available on the IGA website. NB the Opticare and Opticare Arthro devices are suitable for most (but not all) eye drops and are available on prescription. All other devices are available for purchase by patients. 1 Assessing the adherence behaviour of glaucoma patients to topical eye drops; Lussen at al, Patient Preference and Adherence, Dec 2014 http://www.dovepress.com/getfile.php?fileid=22945 2 http://www.glaucoma-association.com/about-glaucoma/treatments/eye-drops/taking-your-eye-drops
Criteria and Standards Audit Criteria Standard Patients describe or demonstrate good eye-drop technique 90% Patients report leaving sufficient time between instilling different preparations An appropriate compliance aid is made available to patients requiring one. Patients are supplied with appropriate quantities of eye drop preparations Patients report storing eye drop preparations in accordance with manufacturer recommendations 90% 100% 100% 90% Method Take time to read the audit forms, thoroughly, then plan what needs to happen and who needs to be involved, including what you want them to do. Communicate the process to those who need to know e.g. healthcare assistants, dispensers, technicians, locum pharmacists, etc. and decide who will be responsible for returning the forms to Powys Health Board once completed. There are two styles of record sheet which must be completed. The first Data Collection Sheet is used to record information obtained during discussions with individual patients who are prescribed eye drops for the treatment of glaucoma. The Data Summary Sheet collates all the information from the individual data collection sheets into a single document. Both have been designed to be simple and should take little time to complete. You will not be required to return any patient identifiable information. It is important that all dispensary staff are aware of the audit and understand that when a prescription for an eye preparation indicated for glaucoma is presented, they must alert the pharmacy team member leading the audit. Each time a prescription for an eye preparation indicated for glaucoma is presented the pharmacist (or another member of staff) should complete a Data Collection Sheet following a discussion with the patient. Where the patient is not available or is unable to participate in a discussion, pharmacies should consider if a carer or relative is able to provide accurate information on behalf of the patient. If there is doubt, the pharmacy should not complete the data collection form but should wait for a more suitable opportunity to present. Audit data must be collected for a maximum of 30 patients during any 4 week period in January to March 2017. Where appropriate, pharmacies should provide patients with advice and support necessary to address any issues identified during discussions. If in the pharmacist s professional judgement a Medicines Use Review (MUR) would be of benefit to the patient, this should be undertaken as soon as is practical.
Once the 4 week data collection period has been completed, or data has been collected for 30 patients (whichever occurs first), the pharmacy should return completed Data Summary Sheets to Jason Carroll, Medicines Management Dept, Powys THB, Basil Webb, Bronllys Hospital, Brecon, LD3 0LU, retaining a copy for your records. It is not necessary to return completed data collection sheets but please retain these should the IGA wish to undertake additional data analysis. The International Glaucoma Association The IGA is a charity set up to help prevent glaucoma blindness and to support people with glaucoma and the professionals who work with them. They can support patients and professionals by: Providing expert advice and information through our telephone helpline Sightline Tel. 01233 64 81 70, Monday Friday, 9.30-5.00. Producing a range of free booklets and leaflets aimed at patients, carers and professionals. This information is available on request by post, or via our website, which also hosts an online patient forum www.glaucoma-association.com. Supplying a full range of compliance aids - available by phone or online. Providing regular member newsletters covering issues related to living with glaucoma and developments in medical treatments. Organising an annual UK National Glaucoma Awareness Week 12-18 June 2017, please contact us if you would like to receive promotional materials for patients and professionals. Organising patient support groups in eye hospitals and community settings, where people living with glaucoma can hear from experts in the field, and share their experiences. Raising awareness and understanding of the condition, and reducing needless sight loss by encouraging people to take care of their eyes especially those most at risk. The IGA also funds an annual programme of glaucoma research, and supports the IGA Professor of Glaucoma and Allied Studies at University College London. We represent patients on the steering committees of research and clinical trials, and campaign for improved quality of care and services at local and national levels. The IGA works throughout the UK, and has a dedicated Development Manager covering Wales Eryl Williams, who can be contacted on 07856 687931 or e.williams@iga.org.uk