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* = Presenting author

P306 Embedding pharmaceutical care into the multidisciplinary team

A. St.Clair Jones*1, M. Smith2

1Brighton and Sussex University Hospitals NHS Trust, Pharmacy, Brighton, United Kingdom, 2Brighton and Sussex University Hospitals NHS Trust, Gastroenterology, Brighton, United Kingdom

Background

Pharmacists traditionally do not get involved in the long-term management of patients with chronic disease.

This service development aimed to integrate pharmacy-lead IBD medication optimisation into the IBD Multi Disciplinary Team (MDT).

We report our experience of extending our specialist pharmacist's remit.

Methods

1. A weekly pharmacist outpatient clinic was established, to initiate immunomodulating drugs and undertake biochemical monitoring. The pharmacist optimised therapy according to blood levels, adverse drug reactions (ADRs) & concordance.

2. Strategic and operational management of the biologics infusion clinic was transferred to the pharmacist.

3. A new blood & therapeutic drug monitoring (TDM) service for immunomodulators & biologics was introduced to optimise therapy decisions.

4. The rapid access (helpline) service was reviewed to see whether the pharmacist could add value.

5. The pharmacist facilitated MDT-approved pathways to initiate and review immunomodulators.

6. A workload and prescription audit was conducted over four months with financial impact assessment.

7. Patient & anonymous colleague feedback was sought.

Results

1. In the four months analysed, 14 pharmacist clinics were held, serving 138 patients. 382 patients had blood monitoring, ensuring clinical governance.

2. The biologics infusion clinic expanded to include a cross-speciality services.

3. 65 patients had their immunosupressant therapy adjusted in the TDM service. The pharmacist is gatekeeper for testing and is responsible for optimising therapies (as a non-medical prescriber).

4. The advice sought from the rapid access service was primarily nurse-orientated and the service remains nurse-lead, with pharmacist deputising to maximise resources. In 4 months 142 of 1032 queries were answered by the pharmacist.

5.The MDT reviewed 42 patients on biologics according to the new pathways.

6.The TDM service resulted in a minimum of £60,000 savings for the health economy.

7. 6 of 6 peer-assessors returned overwhelmingly positive reviews of the service and patient feedback was favourable.

Conclusion

Involving the pharmacist in all aspects of the long-term care of patients with IBD enhanced patient safety and standardised treatment & monitoring protocols, whilst individualising therapy.

The focus of the MDT shifted to early medicines optimisation, realising considerable cost savings. Interprofessional relationships profited from working closely together / deputising for each other.

Embedding pharmaceutical skills into the multidisciplinary team influenced therapeutic decision making, ensuring that services incorporated good medicine management and medicine optimisation principles at conception to guarantee high-quality, compassionate care and strong governance.