Final Version 08.01.15
CommunityPharmacyFalls Prevention Service Specification
NHS Doncaster CCG
Period: 1st April 2015 to 31st March 2016
Introduction
This service specification outlines the service to be provided.
The specification of this service is designed to cover enhanced aspects of clinical care of the patient, all of which are beyond the scope of essential services. No part of the specification by commission, omission or implication defines or redefines essential or additional services.
The pharmacy providing the service must fully comply with the NHS Pharmaceutical and Local Pharmaceutical Services regulations 2013 available at: http://www.legislation.gov.uk/uksi/2013/349/contents/madefor the delivery of Essential Services and be registered with the GPhC.
All staff working in the pharmacy providing the service must conform to the NHS code of practice on confidentiality. All staff working in the pharmacy providing the service must conform to the Data Protection Act.
Background
The aim of this specification is to enable pharmacy to play an even stronger role at the heart of more integrated out-of-hospital services for patient’s that deliver better health outcomes, more personalised care, excellent patient experience and the most efficient use of NHS resources.
Description of Service
This community pharmacy service aims to address the issue of primary prevention of falls and fractures: identifying patients at risk and preventing the first fall/fracture.
Patients aged 65 years and over taking three or more medicines or patients prescribed ‘high-risk/culprit’ medication (appendix 1) will be targeted for a face to face consultation with a trained pharmacist who has undertaken targeted falls prevention training.
During the consultation the pharmacist will enquire about falls history, side effects which may contribute to falls, identify any culprit/high-risk medicines, perform an assessment of gait/balance using the ‘Turn 180° test’ (appendix 2)and ask the patient if they have any problems with vision or continence. All patients will be provided with oral falls and fracture prevention advice (appendix 3) and given a leaflet to take home (appendix 4).
A checklist has been devised for the pharmacist to use during the consultation to ensure a high quality review is conducted (appendix 5).
This service can be used as an extension of the existing Medicine Use Review (MUR) service or if the patient is not eligible for a MUR or for example the pharmacy has reached the 400 yearly MUR cap, then it can be provided as a stand alone service. Patients who have fallen in the past year will be referred directly to the Specialist Falls Clinic at TickhillRoadHospital and a GP notification form will be completed for patients identified as having falls risk factors that the GP may not be aware of. Any adherence issues identified to bone protection medication that cannot be resolved by the community pharmacist will also be highlighted to the GP.
The part of the pharmacy used for the provision of the Falls Prevention Service must meet the requirements of the MUR specification for consultation areas:
- The consultation area should be where both the patient and the pharmacist can sit down together
- The patient and pharmacist should be able to talk at normal speaking volumes without being overheard by any other person (including pharmacy staff)
- The consultation area should be clearly designated as an area for confidential consultations, distinct from the general public areas of the pharmacy.
Patient Recruitment
Patients may be recruited in to the service in the following ways:
- Self referral following advertising of service
- Presenting in pharmacy following a fall
- Identified by dispensing staff during dispensing process.
Inclusion Criteria
Patients eligible for inclusion in this service:
≥ 65yrs on 3 or more medicines
≥ 65yrs and have fallen/been frightened of falling in the past 12 months
≥ 65yrs and currently prescribed a ‘culprit/high risk’ medicine
Patients referred to the pharmacy by another healthcare professional
Falls Clinic Referral Criteria
Patients identified as having fallen in the past 12 months: refer patient directly to Tickhill Road Specialist Falls Service (SFS) via their referral form (appendix 6) Include additional information identified e.g. culprit/high risk medicines, fall inducing side effects etcon this form. Fax/post/secure email the referral form to SFS.
GP Notification
Patients identified as at risk of falling but who have not fallen in the past year and the pharmacist feels there are falls risk factors that the GP should be aware: complete a GP notification form informing the GP of the falls risk factors identified (appendix 7).
For example the types of issues that would be appropriate to include on a notification form:
- Frequent side effects
- Patient has been sign posted to optician as they are experiencing vision problems.
- Patient has continence problems which they have not previously raised with their GP or which have worsened.
- Balance/gait problems that the GP may not be aware of.
- Patients identified as having a previous fragility fracture but are not currently prescribed bone protection.
- Patients identified as experiencing compliance issues with bone protection medication that cannot be resolved by the community pharmacist.
Pharmacist Interventions
Interventions made as part of this service, but not exclusively include:
- Advice on managing side effects e.g. patients experiencing dizziness on rising from sitting or standing to be advised to rise slowly.
- Identification of patients who have fallen in the past year and are referred appropriately.
- Identification of patients with vision problems not corrected by glasses sign posted to optician.
- Identification of compliance issues with bone protection therapy.
- Falls and fracture prevention advice e.g. lifestyle advice and home hazard advice.
Accreditation
The service shall be provided by a practising pharmacist, registered with the General Pharmaceutical Council of Great Britainand who declare themselves as competent in falls awareness, evidenced by completing appropriate CPD.
Monitoring
The Pharmacy should retain a copy of Appendix A and Appendix B for their records. NHS Doncaster CCG reserves the right to review and/ or audit data in relation to payments processed for this service.
Monthly monitoring should be sent to the CCG by way of an invoice detailing the following information:
- Number of patients reviewed
- The registered practice of the patient
- Age of patient
- Falls risk factors identified
- Outcome; i.e. advice, referral to Tickhill Road Specialist Falls Clinic, sign posting, GP notification of risk factors etc
Appendices