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Problem: Practice staff including nurses and pharmacists have worked hard to review patients opportunistically to explore carbon saving options. However, it is a labour-intensive process and requires patient support and lengthy discussions, hence progress has been slow. Prior to the Covid pandemic patient reviews were predominantly carried out face to face to ensure understanding and check inhaler technique.
Intervention: To accelerate progress toward targets, the PCN lead pharmacist ran local technician training to ensure their understanding was robust. The team developed standard operating procedures for technicians to systematically review specific patient groups using different high carbon inhalers. Technicians worked within practice teams including nurses and pharmacists to ensure a safe, consistent and agreed practice approach, establishing who to refer patients to, when necessary. Where patients did not want to change, they were coded on clinical systems, DPI not indicated, which helped achieve IIF targets and ensure patients where not rechallenged. This approach was implemented after the Covid pandemic when patient contacts were routinely carried out via telephone, but with an ability to send information links by text or email, including inhaler technique videos. Often patients were offered to trial a new device with the option to change or decline later.
Effects of changes During the period Sep21-Mar23, PCN prescribing improved from 16th to 2nd percentile carbon impact salbutamol; 33rd to 4th percentile for reduction of non-salbutamol MDIs. All local PCNs reached lower carbon salbutamol targets. The PCN achieved 41% DPI use, the only one of 15 local PCNs to achieve part of the challenging national DPI target (35-44%).
Conclusions: Using a systematic PCN pharmacy technician review approach has speeded local progression to lower carbon inhalers using a skill mix approach. Carrying out reviews by telephone proved to be a viable option and many patients continue to choose this medium for medicines review over face to face. Patient feedback for technician contacts to discuss medicines use has been very positive. Currently technicians are working on wider respiratory good practice targets, including reviewing overuse of salbutamol, by reviewing system set up and establishing red flags with practice staff.
