DAA Service VSMR Instructions for Pharmacists

1 D9132 04/09 Dose Administration Aid (DAA) ServiceVeteran s Six Monthly Review ( vsmr ) Instructions for PharmacistsThis form is to be completed ONLY after the veteran s 20th week of DAA this formThe Veteran s Six Monthly Review is intended to: assist you (the pharmacist) in assessing the veteran in his/her use of the DAA so you canprovide a recommendation to the GP whether to continue the Department of Veterans Affairs (DVA) DAA Service for the veteran; and define the current DAA Service being provided to the form, when completed, is a confidential document as it contains patient s medicaldetails and you need to do1)The veteran must be interviewed for this review. If interviewed in the pharmacy it is essential the veteran brings ALL of theirmedicines (including non-prescription items and those no longer used). If interviewed in the veteran s home please ask to see ALL )Explain to the veteran that: this review is to assess whether the DAA is helping them and to assist their GP, thepharmacy and DVA in providing a better Service ; questions in relation to a carer do not in any way diminish the right to use the DVADAA Service .

2 The purpose of the DVA DAA Service is to assist the veteran and/or carerin managing the veteran s daily quality use of )Complete the vsmr form Summary Page 1 of the vsmr form is a summary and should be completed afteryou have conducted the interview. Section A Questions in Section A are intended to help you make an assessment ofthe veteran s use of the DAA in the last six months and ensure that the DVA DAAS ervice is tailored to support their specific lifestyle requirements. Section B Questions in Section B are intended to help you assess the need forcontinuation of the DVA DAA Service . The questions are based on the criteria listed bythe Pharmaceutical Society of Australia, Guidelines and Standards forPharmacists, Dose Administration Aids Service , July 2007 (PSA Guidelines)and DVA DAA Service information and note: DVA s DAA Service only funds DAA types that are tamperproof andcomply with the PSA Guidelines.

3 Section C Questions in Section C are intended to gauge the veteran s opinion ofthe DVA DAA completing the interview and review, complete page 1 of the vsmr form with yourrecommendations to the )Fax the completed formWhen completed, fax pages 1 7 of this vsmr form to the veteran s GP. This completedVSMR form must be received by the referring GP before an ongoing authority prescriptioncan be issued by pages 1 7 of this completed vsmr form to the veteran s 04/09 Dose Administration Aid (DAA) ServiceVeteran s Six Monthly Review ( vsmr )Pharmacist s Report ConfidentialVeteran s detailsFamily nameGiven name(s)Summary of recommendations To be completed AFTER completing pages 1 7 of this vsmr approval numberDVA file type:GoldWhiteOrangeDate of birthPlease note: The information on this form is intended only for the recipients named above.

4 If received in error please contact the sender immediatelyand destroy all copies. This facsimile transmission contains personal information which is protected by the Commonwealth Privacy Act number of pages in this fax transmissionFROM:Pharmacy (sender)NamePhoneFaxExpiry date of current DAA scriptPharmacy name and address( )( )MaleFemale1 Continuation of the DAAS ervice for this veteran is:RecommendedNot recommended2 This recommendation is made onthe basis that the veteran currently:a)has adequate support systems in place to access anduse DAA s safely and effectivelyYesNob)has a continuing need for the DAA ServiceYesNoc)has expressed willingness to continue with the DAA ServiceYesNo3 Other factors for GP sconsiderationPharmacist s nameDatePharmacist ssignature4 Has your pharmacy provided more than 50%of services for the veteran s last 6 monthsof DAA use that this report relates to?

5 YesNoTo the GP If you agree with this recommendation,call VAPAC on 1800 552 580 for an authorityprescription approval :General Practitioner (recipient 1)5 Pharmacist sdetailsPage 1 of 7 Confidential PhoneFax( )( )Are you the pharmacist who providedmore than 50% of services ?YesNoVAPAC use onlyAuthority NumberD9132 04/091 Where was the vsmr conducted?2 Whose responses are recorded?3 Was the veteran using a DAA priorto starting the DVA DAA Service ?For how long before changingover to the DVA DAA Service ?YesNoyearsmonths4 How does the veteran mainlyobtain the DAA?6 Has the type of DAA being usedchanged during the last 6 months?Reason for changeYesNo7 Has the veteran s medicine changedduring the last 6 months?5 Number of DAA packs per weekCollected weekly?YesNoSECTION A Background and pharmacist s activity to supportthe DVA DAA Service during the last 6 monthsPage 2 of 7 Confidential HomePharmacyOtherVeteran sCarer sVeteran s and carer sCollected from pharmacyHome deliveredOtherOnceHow many times?

6 YesNo2 5 timesMore than 5 times8 What do the pharmacy s recordsfor this veteran show as thenumber of current medicines? Include non-prescriptionmedicines in total count. Double strength doses should becounted as 2 current )Total number of current regular oral solid medicinesb)Total number of current non-solid medicinesc)Total number of current short term and asrequired (PRN) medicines9 During your discussion with theveteran/carer, what were the maincomments/subjects raisedregarding the DVA DAA Service ?a)Main positive comment/subject raisedb)Main negative comment/subject raisedc)Comments on possible improvements to the DVA DAA Service arrangements10 During the past 6 months, what areyour observations of the veteran sDAA use?Has managed medicines adequately, including packed and non-packedIs managing the packed medicines, but noticeable decline in use ofnon-packed medicinesAll packed medicines not always usedUnable to refill DAA prescriptions on timeConfused by DAA being repacked when medicines changeOther11 What activities have beenundertaken by the pharmacy tosupport the DAA Service ?

7 (Tick all that apply)Maintain Veteran DAA profileA Home Medicine Review (MedicareBenefits Schedule Item 900)Monitor DAA useOtherDateAssistance to help with adherence of non-DAA medicineEducation in the use of the DAAR eminders for renewing prescriptions ( calendar/list)D9132 04/0912 Has communication betweenthe GP, veteran andpharmacist increased throughinvolvement in the DVA DAAS ervice?ReasonsYesNo13 SUMMARYO verall, does the veteranaccess and use DAA ssafely and effectively?YesNoSECTION A continuedPage 3 of 7 Confidential Counselling on medicine storage conditionsThe questions in Section A should provide you with adequate consideration to provide aresponse to Question 2a on the Summary of Recommendations on Page 04/09 SECTION B Pharmacist s perceptions on the veteran s needto continue DAA use15 What support do you have inmanaging your medicines?

8 Ask the veteran to get out ALL their medicines, including herbal medicines, vitamins and any other medicines even if they are notcurrently taking 14 is related to Question 8 and seeks to assess concordance between what the veteran is taking and what is in thepharmacy records. Response to this question will also provide an indicator of the veteran s understanding of the number ofmedicines, complexity of their treatment and potential through all the medicinesthe veteran has brought out, whatis the total number of medicines? Include non-prescriptionmedicines in total count. Double strength doses should becounted as 2 current )Total number of current regular oral solid medicinesthe veteran is taking (include medicines in the DAAand medicines not in the DAA)b)Total number of current regular non-solid medicinesPage 4 of 7 Confidential Minimal support, if any ( you live alone)Occasional assistance ( you live independently but with periodic help)Routine assistance ( you have a regular carer)Complete assistance ( someone prepares and helps you to take your medicine)c)Total number of current short term and PRN medicinesd)Total number of medicines not currently being taken,including expired medicinesAsk the veteran the following 7 questions ( Questions 15 21).

9 These questions are meantto examine how well the veteran feels they are coping with their general, how often duringthe last 4 weeks did you:a)feel you were in good health?b)find that you were unable to refilla prescription before your supplyof medicine ran out?c)feel that you were careful intaking your medicines?d)stop taking your medicine becauseyou felt worse after taking it?e)forget to take your medicine?f)take your medicine at the sametime each day?g)not take your medicine becauseyou felt better?h)follow the doctor s instructionsfor taking your medicine?17 Has the DVA DAA Service helpedyou take your packed medicinesas your doctor has instructed?YesNo18 Has the DVA DAA Service helpedyou with your non-packedmedicines?YesNo12345 Not at allAll of the time(more than10 times)Rarely(only 1 or2 times)Sometimes(between 2and 5 times)Most of the time(between 6and 10 times)1234512345123451234512345123451234 5 Page 5 of 7 Confidential As the pharmacist, please answer Questions 23 27 from your own perspective recommends that the ongoing provision of the DVA DAA Service is in accordance with the principles outlined in thePSA Guidelines and Standards for Pharmacists , Dose Administration Aids Service , (July 2007).

10 Questions 23 27 relate to Section 4 of the PSA Guidelines and Criterion 2 of those guideline s the veteran have anyproblems using the DAA?YesNoa) Please specify problems observedConfusionForgetfulnessManual dexterity ( opening containers)OtherVision ( difficulty reading Instructions )Literacy/language problems ( difficultiesunderstanding Instructions )Ability to take medicines ( difficulties swallowing)Dislikes one or more medicines ( due to side effects)Inadequate support networkb) If problems have been identified, how is the veteran being helped?24 Does the veteran have a complexregimen of medicines?25 Does the veteran have a medicalhistory suggesting problemsmanaging medicines ( priorhospitalisation due to pooradherence)?YesNoPlease specifyYesNoPlease specify complexitySeveral routes of administrationMultiple doses per dayMultiple non-DAA packed itemsOther22I would like you to think of ascale between zero and onehundred19In the past 6 months did you goto your GP, or to hospital,because of problems with yourmedicine ( dizziness, fall)?