A service evaluation of new independent prescribers within a COPD Team

Purpose

Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the world (Barnes, Celli 2009) and an estimated 1.2million people in the UK are diagnosed with COPD (BLF, 2019). The NHS Long Term Plan (2018) is encouraging supported care, achieving value in prescribing and improving integration. Community respiratory teams are key to providing specialist multidisciplinary support in pharmacological and non pharmacological management of people with COPD and other lung diseases. With the national drive to provide more care at home, the number of community respiratory teams are increasing.

In this Respiratory Team 3 clinicians undertook Non-Medical Prescribing qualifications at Masters Levels: 2 physiotherapists and 1 nurse. Each prescriber has a personalised formulary within their scope of practice and treat complex respiratory patients.

There is very little research found to ascertain non-medical prescribing habits within a community respiratory setting. This service evaluation aims to review actual prescriptions versus the expected prescriptions between April and September 2018, we hypothesise that we will prescribe mostly inhaled therapy.

In total 3 clinicians issued 56 prescriptions
for 72 patients over a 6-month period.
50% of prescriptions were inhalers,
4% oral steroids...

...15% antibiotics,
9% nebulisers (saline 0.9% and Salbutamol)...

...9% antifungals,
7% mucolytics and 6% other (spacers).

Approach

Patients with a respiratory diagnosis (COPD, bronchiectasis and ILD) were included in this service evaluation throughout all pathways the service offers: admission prevention, early supported discharge, pulmonary rehabilitation and symptom management. The data was extracted from the personal records of each prescriber in accordance with HCPC/NMC standards. These were amalgamated and reviewed to determine actual prescriptions and outcomes, themes were drawn.

Outcomes

In total 3 clinicians issued 56 prescriptions for 72 patients over a 6-month period. 50% of prescriptions were inhalers, 4% oral steroids, 15% antibiotics, 9% nebulisers (saline 0.9% and Salbutamol), 9% antifungals, 7% mucolytics and 6% other (spacers). The most inhaled therapy prescribed were as LAMA's 's and least was SABA's, it was not anticipated that as many antifungals would be prescribed. Long acting muscarinic antagonists (LAMA) - 8, Short acting beta agonists (SABA) - 2, Long acting beta agonist (LABA) / LAMA - 6, LABA / LAMA, Inhaled corticosteroid (ICS) - 6.

Implications

Our findings show that as suspected we have prescribed mostly inhaled therapy. Feedback from prescribers is that continuity of care and implementing therapy in a more timely fashion has been invaluable since qualifying. Less short acting therapy and steroids were prescribed than anticipated. Retrospective analysis leads us to conclude although most patients have rescue packs and short acting therapy insitu, they required more specialist input which was provided via incheck devices and understanding of specific medications. Many patients were on unsuitable devices that they were unable to use and our specialist input improved outcomes and concordance with inhaled therapy. This has an effect on symptom control and exacerbation rates.

We aim to continue to develop our formularies for other problems associated with lung disease such as oral candida and reflux to enhance the care we offer and keep up to date with new therapy for chronic lung disease. Further research on non-medical prescribing within a respiratory setting nationally would be beneficial to determine further benefit in respiratory disease.

Funding acknowledgements

This work was unfunded but supported by managers and the NHS as it was done during working hours.

Additional notes

This work was presented at Physiotherapy UK 2019.