Pharmaceutical care of asthma patients - · PDF file5 Presentation slides - Asthma: ... The...

Pharmaceutical careof asthma patients

Module 2Asthma: Beyond the 5 steps


Module 2Asthma: Beyond the 5 steps

page 3 Introduction 5 Presentation slides - Asthma: Beyond the 5 steps 18 Implementing the NES asthma pharmaceutical care plan 19 NES asthma pharmaceutical care plan 21 Case study 1 23 Case study 2 24 Case study 3 25 Post Course Activities

This pack was brought together with the help of DrAnne Boyter, Senior Lecturer, Strathclyde Instituteof Pharmacy and Biomedical Sciences, University ofStrathclyde.

While every precaution has been taken in thepreparation of these materials, neither NES nor externalcontributors shall have any liability to any person orentity with respect to liability, loss or damage causedor alleged to be caused directly or indirectly by theinformation therein.

While documenting your CPD entries for the RPSGB, youwill be asked to estimate the time spent on your CPD. Inan attempt to assist you with this, the table below givesa rough guide to the number of hours you may wish tospend on each activity.

Acknowledgements

Disclaimer

An estimate ofCPD times

Activity Number of Hours

Completion of pre course activities:• Completion of Module 1 (A revision of

Asthma including MCQ assessment) 2.5 hours

Attendance at the Asthma CORE evening event 2.5 hours

Completion of post course activities:• Completion of Module 2

(Asthma: Beyond the 5 steps)

INCLUDING

• Submission of 3 pharmaceutical care plans from practice

PLUS

• Submission of a copy of 2 RPSGB CPD entries as a result of the learning obtained from Module 1 and 2 2.5 hours

2 Pharmaceutical care of asthma patients Module 2


This course offers Scottish pharmacists training on how theycan contribute, as part of their normal working practice, to thecare of people who have asthma by applying the principles ofpharmaceutical care for patients with chronic diseases. Thisinvaluable training for community pharmacists will help preparethem for the future and should link with previous NES CoreCourse materials.

The evening will start with a lecture on asthma – mainly coveringthe disease, acute management and secondary prevention. Thiswill be delivered by a local expert and will explore the aims oftreatment and review the various clinical management options forthe disease. The workshops will include very practical patient casestudies followed by a group discussion on ways to improve care.

The course will be of interest to pharmacists working in bothsectors of care in order to help with integrated seamless careand will provide a useful CPD opportunity on the currentrecommendations for the management of asthma patients.

To revise basic lung physiology and the pharmacology of asthmatreatments and to update chronic disease management ofasthma.

At the end of the session participants will be able to:• Revise the physiology of the lung by completion of Module 1• Outline the current asthma management based on the SIGN/

BTS guideline• Outline the current evidence base for the guidelines• Relate the guideline to management of individual patient cases


Aim

Objectives

Introduction


This entire module is pre-course work

• Module 1: A Revision of Asthma booklet• Both lectures on the DVD, Basic Asthma and Asthma: the 5 steps

should be watched prior to attending the evening (approximately 30 minutes each) (Slides from both talks are available in the Module 1 booklet should you wish to take notes)

• 10 MCQ questions must be completed either on paper and brought along on the evening or done online (www.nes.scot.nhs.uk/pharmacy).

In addition, it is recommended that, before coming along to the course,you update yourself on any local guidelines that exist within your NHSBoard for the treatment and prevention of asthma.

The slides accompanying this module are indicative of those that willbe used in the CORE course evening. The slides may vary depending onthe presenter but should cover some of the areas in these slides.

Pre-course Work

Slides


A NES asthma pharmaceutical care plan has been developed tohelp pharmacists apply their learning, develop their assessmentskills, help their patients get the most out of their medication andreduce any associated risks. It incorporates a simple assessmentand follows the same systematic inquiry as the other chroniccondition PCNA tools in the previous NES Core Courses. A careplan also allows you to document pharmaceutical care issueswhich have been identifi ed during your consultation. Learningto use a care plan will also be useful for when the ChronicMedication Service (CMS) is introduced.

The NES asthma care plan has been designed with direct patientcontact in mind and will help pharmacists to speak with patientsin a more systematic and focused way. You can adapt thequestions to your own style and the needs of your patients. Useit in conjunction with your computerised pharmacy medicationrecords to identify patients you would like to actively target.

Ten blank care plans are available in your core pack. Please usethese when attempting Case Studies 1-3. There are extra careplans for post-course activities.

Implementing the NES asthmapharmaceutical care plan


Pharmaceutical Care Needs AssessmentAsthma

Name Doctor’s name

Date of birth or CHI no. Date

Can you tell me what medical condition(s) you have? Or have had?

dose frequency no ordered monthly

What is/are the name(s) of the medication you take for your condition(s) and how do you take it/them?

yes no

Do you ever forget or choose not to take your medication? If yes, how often – weekly/monthly?

Do you know what to do if you have missed a dose of your medication?

What, if any, side-effects do you experience from your medication?

yes no

Do you feel that your medication is controlling your symptoms or have you noticed any changes since you started taking your medication? Do you know the trigger signs?

Do you have a regular check/blood test/review? Can you tell me when that was, and the outcome?

Would you like any information/advice on anything about your condition/medication/health promotion areas?

Do you smoke? If yes how many cigarettes and for how long?

Specific asthma questions

Please show me your inhaler technique?

Do you wake at night coughing or wheezing?

How often do you use your reliever inhaler each week?

Does your asthma stop you doing anything that you want to do?

If you have a peak flow meter – what is you most recent PEFR?

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9


Pharmaceutical Care Needs AssessmentAsthma

Care Issue/Desired Output Action Output


Mr Thomson, a 32 year old asthmatic who is well known to youcomes into your pharmacy. He is known to have a best peak fl owof 640 L/min. He tells you that over the last few weeks he has beenwakening up once or twice a week coughing, and he is using hissalbutamol inhaler a couple of times a day. He has recorded hismorning and night-time peak fl ows these have averaged 580 L/minand 540L/min respectively. He has recently changed his job and isnow working in the open air rather than in an offi ce.

His PMR shows that he has been maintained on

salbutamol MDI, 2 puffs as requiredbeclometasone 100 MDI, 2 puffs twice a day (recently changed tonon CFC (Clenil Modulite))

for the last four years. He also buys antihistamine tablets from youduring the summer.

His prescription today is for a Seretide® MDI 50, 2 puffs twice a day.

Based on the information available construct a care plan for MrThomson. He is under pharmacist care for his asthma. Includein the plan the immediate management of the patient and themonitoring you would carry out to ensure that the patient isbenefi ting from your plan.

One month later Mr Thomson returns with a repeat prescription forhis Seretide® 50 inhaler. He tells you that he feels a little better andis now sleeping but his peak flow still only averages 600 L/min and isusing his salbutamol inhaler 6 times a week.

Case Study 1


At this consultation update your care plan for this patient.

Include in your plan any monitoring for the patient and anysuggested changes in therapy. What would you use as criteriafor referral of this patient to the GP or secondary care?

Six months later Mr Thomson is admitted to hospital with anexacerbation of asthma. On admission his pulse is 120 beats perminute, his respiratory rate is 28 breaths per minute and his PEFRis 390 L/min.

How would you defi ne Mr Thomson’s asthma control now?

What would you include in his care plan now? Could MrThomson be managed in the community or does he need to beadmitted to hospital?


You are asked to dispense a prescription for Angela, age 10 years, for

salbutamol MDI, 2 puffs when requiredSeretide® 50 Evohaler , 2 puffs twice daily

Angela has been a patient of your pharmacy since she was a smallchild and has suffered from eczema and hay fever since she was 3years old. Two years ago she was diagnosed with asthma and herGP has commenced this prescription. You know that she has beenreferred to the local hospital to see the respiratory paediatrician asher asthma was not controlled on Seretide 50, 2 puffs twice a day.She saw the hospital paediatric respiratory consultant last week.

Construct a care plan for this child.

In the care plan you should include prescribing, monitoring andfollow-up for Angela. Indicate when you would expect to see heragain and how often she should attend for follow-up. What otherhealth-care professionals would you involve in the care of thispatient.

Angela is discharged from hospital following an acute exacerbationshe is now prescribed

salbutamol MDI, 2 puffs as requiredSeretide® 125 Evohaler, 2 puffs twice dailyprednisolone 50mg, 3 days to complete a 5 day course

How would you alter the care plan for Angela following herhospital admission? Does this change the monitoring and follow-upfor the child?

Case Study 2


Mrs White, a 35 year old woman who is 28 weeks pregnant, comes into your pharmacy on a Saturday afternoon with a repeat prescriptionfor a terbutaline turbohaler. She last received a prescription forterbutaline 10 days ago and on that occasion received 2 turbohalers.From your PMR you note that at the same time she was alsoprescribed:

Symbicort® 100/6 Turbohaler 2 doses twice daily

On questioning Mrs White regarding her symptoms she says herasthma is usually worse at this time of year. She has used her lasttwo terbutaline turbohalers and that although you dispensed theSymbicort® she has not been using these for the last six months asshe was concerned about the effect that the corticosteroids mayhave on her unborn child. She has been using up all the terbutalineinhalers that she had at home and is now wheezy.

Mrs White is breathless.

What is the immediate care that Mrs White requires? How can thisbe delivered?

Construct a care plan for Mrs White to deal with herbreathlessness. Include in this recommendations for prescribingand monitoring

Mrs White returns to your pharmacy with a prescription for

prednisolone, 50 mg each morning for 7 daysSymbicort® 100/6 Turbohaler 2 doses twice dailyterbutaline turbohaler, as required

Mrs White requests that only the terbutaline is dispensed.

Update your care plan for Mrs White. Include in this thecounselling that you would need to undertake to ensure that MrsWhite has an effective prescription.

Case Study 3


You should complete two RPSGB CPD entries. One of theseshould be based on the educational session you have undertakenand one should be related to changes in patient managementthat have resulted from the session. Copies of these completedRPSGB CPD entries can be submitted to NES.

At the end of this course you should construct threePharmaceutical Care Plans for patients you have seen in yourpractice. You can then submit these completed care plan to NES.If required you will receive one to one remedial feedback andsupport on the care planning process. A general summary of careplan feedback will be posted on the NES website at the end ofthe current education and training year. All documentation yousubmit will be anonymised and may be used for the purposes ofresearch and development of the service. If you would not likeyour submissions used for this purpose, please indicate this to usin writing.

CPD entries

PharmaceuticalCare Plans

Post-course activities

NHS Education for Scotland (Pharmacy)3rd Floor, 2 Central Quay

89 Hydepark Street

Glasgow G3 8BW

Tel: 0141 223 1600

Fax: 0141 223 1651

www.nes.scot.nhs.uk/pharmacy

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