managing medicines - CPPE

1 An open le arni ng programmefor ph arm acis ts and pharmacytech nici an sOlderpeople:managingmedicinesDL P150Ed uca tion al solutionsfor the NHS phar macy wor kf orceAn ope n lea rni ng pr og rammefor phar ma ci sts and pharmacy techni ci ansOlder people:ma na gingmedicinesEd ucatio nal solutio ns for the NHS pharmacywork force Co pyright con tro llerHMSO201 0 Ackno wle dge mentsLead writerLellyOb oh , con su lta nt pha rm ac ist , car e of olderpeople, NHSL ambeth,Eas t &South Ea st En gla nd Specia li st Ph arm acy Servic es NHST rustWi th post -pi lot ad dit io ns by:Na om i Burns,medicinessafetypharmacist,Wester nSu ss ex Hospitals NHSTr us tCP PE pro gr ammede ve loperPa ulaHi ggin son, seni or ph ar ma ci st lea rningdev elo pmentWi th con tr ibu tion s fromex ter na l programmedeveloper : Simon Lloyd,medicalwri ter.

2 Re vie wer sNi na L Barn et t, con su lta nt ph ar ma ci st, careof old er people, East& So ut h Ea stEngla nd Specia lis t Pharma cy Services, andHarrowPrimaryCareTrustNa omiBurn s, medic in es safety pha rmacist,WesternSussexHosp it als NHSTrus tTh is lea rn in g programme wa s pi lot ed na tionallyby thefo llowingpharmacists an dph ar ma cy tec hni ci ans : Ju li e Loft s-Constable, Ro semary Lim,SusanMinney,Ka renNewman, GeorgePendlebury , Jill So uthworth, od uctio nOu ts et Publi sh ing Ltd, East Sus sexPubli sh ed in Ja nua ry 2010by the CentreforPharmacy Po stgraduate Education ,Sc hoolof Ph ar ma cy an d Ph ar ma ceut icalSciences,Univer sityof Manchester,Ox fordRoad, Manches ter M139 PThttp :// www .cpp .ukPrintedon FSCpa per st ocksusingvegetablebas ed inks.

3 IiTT-COC-002529 ContentsAbout CPPE op en learningprogrammesviiAbout thi s le arni ng programmexiSuppor ti ng you, your practiceand the NHSxivSecti on 1 Ol de r peopleand healthcare11. 1 You and you r pra ct ice11. 2 Olderpeopleas a group31. 3 The agei ng pop ulat ion an d health31. 4 Healt hc are set tin gs4 Careat home4 Soc ia l hou si ng5 Int ermedi at e care5 Careho meswi th nu rsi ng6Ho spi ta l care6 Palli at iv e care71. 5 Poli cy con tex t8 Practic e poin ts7, 9 Reflectiv e ques ti on s1Su mma ry and in ten ded out comes9 Secti on 2 Ageing and medicinesus e102. 1 Physiological cha ngesand ag ei ng102. 2Ph armac oki net ic chang es11 Abs orption11 Dis tr ibu tion11 Metab oli sm12Ex cretion12Es ti ma ti ng ren al fu nc ti on13Es ti ma ti ng GFR13 Chroni c ki dn ey dis eas e and ch ronic renalfailure14 GFRan d eG FR152.

4 3Ph arm ac od ynami c an d homeostaticchanges17 Orth os tat ic ci rcu lat oryresponse17 Balan ce17Th irst and hydrati on18Th er moregulati on18 Alteredrec ept or sens it ivit y192. 4 Cha ngesin physical an d ment al health21 Vis ua l impairm entand lo ss21ii iJ A N U A R Y 2 0 1 0C O N T E N T SHearin g impai rm ent21 Swa llo wi ng di ffi cu lt ies22 Red uc ed mobi li ty andimmobili ty22 Reduc ed man ua l dexteri ty232. 5Ot her fa ct ors23 Behaviou ral fa ct ors23So ci oeconomi c fa ct or s24 Exercises16, 20, 24 , 26 Practi ce poi nt11Su mmary an d int en dedou tcomes28Su gg est ed an swers29Se cti on 3 Pre scribing in agein g323. 1 Polypharmac y32 Conseq uences of polypharm acy34Av oi di ng polyphar ma cy and/o r it s consequences353.

5 2 Adver se dr ug reactio ns35 NSAID s, in clud in g coxibs38Op ioi d ana lg esi cs38Di ureti cs38Di gox in39An ti coa gu lan ts39An ti hyperten sives39An ti pa rkinson s drug s39In su lin an d ora l hypoglyc aem ics39An ti ps ychot ic s40 Benzod ia zepines41An ti cho lin erg ic drug s41An ti bio ti cs an dClostrid ium di ffici le41Ci metid ine413. 3 Medicin es adh erence42A su mmaryof th e NI CE guid eli nes on adherence42St rat eg ies to reduce polyphar ma cy andtherisk of44advers e dru g rea ct ion s, an d impro ve adherenceExercises36, 46 Practi ce poi nt35Su mmary an d int en dedou tcom es47Su gg est ed an swers48ivJ A N U A R Y 2 0 1 0C O N T E N T SSecti on 4 Mana ging medicationri sks504. 1 Identi fyi ng and assess in g old er peopleat risk50 Assessi ng olderpeople:th e si ng le as sessmentpro cess50 Medic inesand ri sk53 Medic inesma nag ement ri sk ass es sm ents544.

6 2 Red ucing ris ks through medici nes management61 Medic at io n review61 Medic inesrec onciliat ion63 Medic inesuse reviews64 Repeatdis pensin g654. 3 Careplannin g664. 4Im plementi ng themedi ci nes ma na gementaspectsof th e67ca re planPractic e poin ts53, 67 , 68Su mma ry and in ten ded out comes68 Secti on 5 Co ll abor ative working705. 1 Commun ic at io n an d medic at io ns management705. 2 The rolesof health and so ci al carestaff71 Commun it y nurses71 Doc tor s73 Healt hc are su pport wo rkers73 Alliedhea lth professio na ls73 Soc ia l care tea m74 Informa l caregivers755. 3 The roleof thepharma cis t and pharmacytechnician75 Commun it y pha rma ci sts75Ph arm ac y technic ia ns77 Specia lis t an d advanc ed levelph ar ma ci sts785. 4 Int egratin g medic inesmana gementintocarepathways79 Exercis e77 Practic e poin ts71, 75 , 76, 77 , 79Su mma ry and in ten ded out comes81Su ggestedansw ers82vJ A N U A R Y 2 0 1 0C O N T E N T SSe cti on 6 Bri ng ing it all to gethe r83 Case stu dy 183Su mmary an d int en dedou tcomes87Su gg est ed an swers89 Ref er ences92 Inde x97 Tab le s and fi guresTa ble1 Cha ng es in receptor s and systemsin olderpeo ple19th at necessit at e caut ion when using certain medicinesTa ble2 Dru gs th at should be used withcaution and37monitoredin peopleover 65Fi gure1 medicines section of the FACEov er viewassessment56version 5.

7 2005Fi gure2Fu ller sself-med ication risk assessmentscreeningtoo l 58Fi gure3Th e nine do ma ins of the risk assessmenttool59Fi gure4Ex ampleof th e ACCES S to medicinessection from60th e LOPSDP in -d ep th med ic atio n as sessmenttoo lviJ A N U A R Y 2 0 1 0 AboutCP PE ope n lea rning prog ra mmesAboutCPPEThe Centrefo r Pharma cy Post gra du ateEducation (CPPE) is fundedby theDe pa rtmentof Health to provide co nt inuingeducationfo r practisingpharmacistsandph armacytec hn ici an s provid in g NHS ser vicesin theWorkf orceAc ademy, wi thi n theSc hoolof Pharmacy andPharmaceuticalSci ences,which is part of th e Fac ult y fo r Medic al fersa wi de ra ng e of lea rn in g opp ortunitiesforthepharmacywork learningportfolio is ava ilableon theinternetat:http: // ww esWehave allocatedthemes to all ou r learningprogrammes.

8 Thereare28 themesintotaland theyallow you to navigat e ea silythroughour full learningportfolio . Wehave assi gneda different co lourto ea ch of our themes, andthisis usedto identifythethe mein theann ua l prospectus , inCPPEnew s&even ts, on ourwebsite,andonthecovers of all thelearnin g le ar ningprogrammeis pa rt of theOlderpeo u will findadditionallea rningprogrammeswi thi n thi s themein our pro sp ectus andon our downloa d thi s programme in PDFfor ma t fromour website:http:/ /ww .ukWere co gniseth at peoplehave different learningneedsand notevery CPPElea rningprogrammeis su it ableforev erypharmacistor phar macy ou r programmescon ta in corelearning, whileother s deliver mo recomple x learningthatis onlyrequiredto support certainroles.

9 So we have createdthree categories of learnin g CPPE1 2 3 andalloca tedea ch pro grammeto anappropria te category .Theca teg ori es are :Corelea rni ng (lim it ed expecta ti on of priorknowledge)App li ca ti on of knowledge (as su mespriorlearning)Suppor ti ng specia li sms(C PPEmayno t be theproviderandwillsi gnpostyou to ot herappropria te learningproviders).This is alea rn ing A N U A R Y 2 0 1 0A B O U T C P P E O P E N L E A R N I N G P R O G R A M M E SContinuingprofession al de ve lop mentYou ca n us e this lea rn in g programme to support yo ur co ntinuingprofessionaldevelopment (C PD).Co ns id er wh at yourlearningneedsare in d it useful to wo rk wit h the infor mationandactivitiesherein a way tha t iscompat ib le wi th the Roy al Pharm aceuticalSocietyof GreatBritain s ap pro ac h tocontin ui ng professio na l developmen t (http: // www.)

10 Rpsg b. org .uk /registrati ona ndsu pp ort/ con ti nui ngpr ofe ss ion al de velopment) becauseyou wi ll be ab le to relateit to you r person al ci rcu ms tan cesmoreclo sheets or goto:http :/ /www .u pto date .o k/to pl an andrecord theactions yo u have rcise sWein clud e ex erc is es through ou t this programmeas a formof self-assessment. Usethemto testyo ur knowledge and un derstandingof key ctic e poin tsPracti ce poi nts are an opportu nit y fo r yo u to consi deryo ur practicalap proach totheeffectiv e careof pa tient s or the provisionof a ti vi ti es des ig nedto helpyou to identifygo od practice,to thinkthroug h thestepsre qu iredto im plement newpra ct ic e, andto considerthespecificneedsof yourlo ca l populati on .Wehavedesi gnedthe pra ct ic e poi nt s in thisprogrammeto helpyo u andyourtea m to ma ke li nks bet weenthe learni ng an d yo ur dailypracticeandto co -ordin atewi th oth er hea lth careprofessi on die sWebas e cas e st udi es on act ua l or cludedto helpyouto in terpretprotoc ols,deal with uncertaintiesandweighup thebalanceofjud gm ent s needed to arri ve at a con clusion.