Recommendations on stability of medicines in multicompartment

compliance aids

acknowledgements

• Regional UKMi centres

• Tiffany Barrett, Michele Skipp and James Turton

• Pharma

• Stella Lee

• Users and other stakeholders

Background

• Common problem – hospital and community

• Lack of, or conflicting, information

• Variable responses from MI service

– Individual patient

– Policy

• RPS guidance on value of MCA

Approach

• Develop a searchable database

• Technical advice

– Not about appropriateness of MCA

• In line with other relevant professional and legal advice

– GPhC, RPS, GMC and NMC

• Preferably open access i.e. outside UKMi network

Guidance and search

tool

Consistency and QA

(SWMIT)

Database

Content (RMIC)

Risk based recommendations

Feedback from pilot phase

• UKMi service

– Regional centres

– 3 local centres per patch

• Stakeholders

– RPS

– Clinical experts

– Authors of previous guides

• Comments and Survey Monkey returns

Survey results

• 518 products were searched by 53 centres

12%

6%

7%

75%

outcome

not listed

listed - adviceunclear

listed - advice notconsistent

listed - advicehelpful

Feedback (2)

• Opening page – Seen as necessary and helpful but needs to be more focussed

– Stress need to apply professional judgement

– Use the “tick box”!!

• Grading system – Generally well liked and useful

– Do we need A1, A2 and A3?

• Advice – Doesn’t give all the answers!

– Very useful comments on individual products • Clopidogrel and fludrocortisone

Next steps

• Making adjustments to the format

• Open access to UKMi network

• Some concerns about complete open access at this point

• Further testing with community pharmacists

• Consider when to make the database access fully open

• Feedback and review

Last 12 months • Further roll out

– UKMi network

– Community pharmacists

– Hospital Dispensary Managers

– Primary care/commissioning pharmacists

• Follow up survey July and August 2014

“Usefulness Survey”

• 21 Responses

– 9 community pharmacies

– 7 MI Services

– Hospital, Practice Pharmacists

• Covering Information

– Similar to 2013 survey

• Usefulness of advice

– 66 out of 68 preps (97%) “Listed and Useful”

Development Survey

Medicines Information department

71.43% 25

Hospital dispensary 28.57% 10

Community pharmacy dispensary

14.29% 5

Community pharmacy dispensary (hub)

0.00% 0

Practice pharmacist or pharmacy technician

5.71% 2

CCG/health board pharmacy team

2.86% 1

How useful was the information in the UKMI MCA stability database?

Answer Choices – Responses –

– Very useful 41% 15

– Useful 43% 16

– Neutral 16% 6

– Unhelpful 0% 0

– Potentially misleading 0% 0

Total 37

Since using the UKMI MCA stability database have you seen a change in

the number of MCAs used in practice - have you seen :-

Answer Choices – Responses –

– More MCAs filled 13.33% 4

– Less MCAs filled 3.33% 1

– No change 83.33% 25

Total 30

Comments

• Sometimes have over-ridden information in view of patient compliance concerns

• Little information of benefit and majority of data says to base on clinical decision

• Initially I felt that the judgements in the database were conservative and may restrict practice, but now that I have used the database for an extended period I find the judgements very useful and they are allowing me to make firm statements that are backed up by a reputable organsiation on the suitability of inclusion in an MCA

The right approach?

• Use the database

• Be familiar with the RPS Guidance

• If the patient requires a MCA

– Try to use products classed as “GREEN”

– Try to avoid products classed as “RED”

– Use your professional and clinical experience to determine, and mitigate, the risks and benefits of using products classed as “AMBER”

Next Steps

• Advocating continuation within SPS commissioning specification

• Ongoing survey and data collection

• Password protection

• Publicity