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Expert team has the right prescription to keep patients well at home

The team stood on a grass bank

Patients are being helped to keep well at home thanks to a team of specialists who manage and review their medication for them.

Pharmacists have been present within virtual wards since they were launched in Swansea Bay in 2021.

Virtual wards provide care and support in the community to people with complex health and social needs.

Rather than a ward made up of hospital beds, the patients’ own beds become part of a virtual ward, meaning they still receive the same level of care but in the comfort of their homes.

Pictured: Virtual ward pharmacists Esther Hughes, Felicity Cameron, primary care principal pharmacist Lorna Collins and virtual ward pharmacists Moussa Bazzoun and Sian Rhodes.

A multidisciplinary team comprising health and care professionals, such as doctors, nurses, pharmacists and therapists, discuss how to plan and manage each patient’s care.

Face-to-face assessment is an important element of the service, ensuring all necessary interventions are completed.

A crucial part of the pharmacists’ role is what is known as medication optimisation, where they carry out reviews to ensure it is safe and provides a clinical benefit for each patient.

Lorna Collins, principal pharmacist within primary care, oversees the team of pharmacists within the virtual wards.

She said: “It’s really important to have pharmacists involved in the service because there are lots of patients on multiple medications.

“Patients could be under several specialities, all prescribing medication to them independently. The patient then takes the medication prescribed but they could affect each other – and the greater number of medications, the increased risk of adverse effects.

“We carry out medication reviews to make sure it does what we want it to do and provides the benefits we would want for the patient.

“We look to remove unnecessary medication from their repeat prescription if it’s no longer needed or no longer suited to them.”

The team also has discussions with patients about their medication, either over the phone or by visiting them at home.

“It’s helpful to have a conversation to understand what that person wants and what is important for them,” Lorna added.

“Some patients could be on multiple tablets and may have to take them multiple times a day.

“By having a conversation we can see if we can alter the medication – there may be a tablet that can cover multiple conditions or a medication that can be prescribed once a day as opposed to three or four times a day.

“It’s about trying to simplify things to make it easier for them.”

Three people sat on a bench with two stood behind them

Virtual wards are available in all eight of the health board’s Local Cluster Collaboratives – Bay Health, City Health, Cwmtawe, Llwchwr and Penderi in the Swansea area, as well as Afan, Neath and Upper Valleys in the Neath Port Talbot area.

Each virtual ward has a pharmacist based within its multidisciplinary team and it means, unlike most other pharmacist roles, they can visit patients at home to discuss their medication.

“We can undertake observations while we’re there, such as blood pressure or pulse checks,” said Lorna.

“So, if we had concerns about whether someone’s blood pressure was too low or high and we wanted to double check it before we recommended any medication changes, we could go out and do that and involve the patient while we’re there.

“We can also do a home visit if the person may not be managing their medication, if they are confused with it or if we are making big changes to it.

“It helps when you’ve got the medication in front of you so you can refer to it and talk about it.

“We can also provide written information, such as a medicine reminder chart.

“We have the benefit of being able to support to some of our most frail and vulnerable, our housebound population, who have struggled to access practice or community pharmacists.”

The World Health Organization (WHO) describes polypharmacy – where people take multiple medication - a major global problem.

This is because around 50 per cent of people do not take their medication as prescribed.

Ensuring medication is safe and suitable for each patient not only benefits their individual health but can also help to prevent potential hospital admissions.

The All Wales Medicines Strategy Group estimates that harm from medications results in 11 per cent of unplanned hospital admissions, with 70 per cent being older patients prescribed multiple medications.

“It’s so important that we get medication right and treat each person as an individual,” Lorna said.

“We follow all the guidelines but we have to take a holistic look at each patient and try to marry up all of the conditions they’re being treated for and all of their medication to ensure we are getting the benefits we want for them.

“While deprescribing is an important element, medication will be added if it is necessary to provide benefit to the patient.

“It’s important to make sure the doses are still safe for each patient or if perhaps it’s time to stop a certain medication and change to something else.

“Lots of patients, when you speak to them, won’t take a tablet because they don’t know what it is for or why it was prescribed.

“Education is really important as well because if you can have that conversation with them, they are more likely to be on board with what they are supposed to be taking. This can help to minimise patient harm and reduce waste.

“It’s all about trying to improve patients’ relationships with their medication and getting them on board with why they are taking it and trying to prevent hospital admissions through medication.”

Dr Anjula Mehta, the health board’s interim Executive Medical Director, said: “The role of the pharmacist within the virtual ward is key to the success of care optimisation and stabilisation of our most vulnerable patients.

“We knew this role would be successful in the context of our core multi-professional team, but we are thrilled to see the very real difference the virtual ward pharmacists make to our patients on a daily basis.”

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