The Pharmacist September/October 2018 - Page 27

Case study Dane Stratton-Powell, professional support manager for the North West, Lloydspharmacy ‘I dealt with a teenage patient who led a particularly lonely life and the highlight of his day was coming to the pharmacy to collect his medication and be supervised as he got to spend time with people who he knew, trusted and got along with. ‘He was unfortunately prone to depression and self-harm and one day his grandad came in to tell me that he had died of an overdose. However, he was keen to reiterate what a huge part we played, as a pharmacy team, in his life and were all invited to a music gig held in his honour. ‘It made us realise what a difference we make in the community but, specifically in this case, that support can be so much more than the provision of medication and an enhanced service.’ Pharmacy in Sheffield, says that a successful supervised consumption service will involve the whole pharmacy team. ‘There is no reason why trained and competent members of staff cannot administer and run the service as long as the pharmacist clinically checks the prescriptions and supervises the overall process and service,’ he says. Supervised consumption is ‘a prime example of how a service can involve all the skills of the pharmacy team’, he adds. Treating patients with respect Mr Daniszewski believes the service is valuable because it can ‘help prevent misdirection of controlled drugs, and this in turn can reduce drug-related deaths in the community’. And from a business point of view, ‘it is also another potential income stream that cannot be overlooked in these challenging times that community pharmacy faces,’ he says. Supervised consumption users, as with all patients, should be entitled to a high standard of care and respect, which includes ensuring the service takes place as discreetly as possible. Mark Joynson, pharmacy manager at The Hub Pharmacy’s Manchester Road branch in Warrington, Cheshire, says the service ‘should take place in a confidential and safe environment for both patient and provider’. He explains that one of the consultation rooms is dedicated to the supervised consumption service. The room is fully closed off from the rest of the pharmacy, and features a hatch connecting to the dispensary, ‘which enables us to provide supervised administration that is out of view of the rest of the pharmacy’, he says. During consultations, pharmacists should treat patients with ‘dignity and respect’, says Ms Maden. ‘All these clients are someone’s relative and no one chooses to end up in this situation. Many individuals have had really chaotic lives and potentially poor historic engagement with any professionals. ‘A high proportion have had adverse childhood experiences. Treating them with dignity and respect can make a huge difference to them, their day and their overall recovery journey. ‘I know of clients who have walked miles to keep to the pharmacy where they aren’t talked down to.’ Mr Joynson says all his patients are treated the same ‘whether they use our service for drug dependency or to collect any other prescription’. ‘Our patients are often going through battles we know nothing about – we keep this at the forefront of the way we help and support our community. The relationships we have built with all of our patients show our dedication to their treatment,’ he says. The right training Most supervised consumption services require pharmacists to complete the Centre for Pharmacy Postgraduate Education (CPPE) I know of patients who have walked miles to come to a pharmacy where they aren’t talked down to Lorraine Maden substance use and misuse training or to complete the declaration of competence for substance misuse training via the CPPE website, says Ms Ruthven. Some commissioners may also require attendance at awareness or engagement events at the start or during the contracted period. As well as delivering a supervised consumption service, service users can benefit from in-house pharmacy services such as needle exchange, repeat prescription ordering and collection, monitoring and offering advice on the service user’s general health and well-being, and signposting them where necessary to different care providers, advises Mr Daniszewski. Be prepared for the unpredictable Some clients may present with challenging behaviours. Mr Daniszewski says it is important to remember that many supervised consumption users have a mental health condition, ‘which is easily forgotten when dealing with someone who, at times can be very impatient, irritable, short tempered and volatile’. ‘If the pharmacy team remains cool, calm and supportive with an understanding attitude when serving supervised consumption users, this can help to prevent incidents or confrontation,’ he says. To help deal with these situations, Ms Ruthven emphasises the importance of ‘three or four-way agreements’ such as arranging set times for pick-up, setting expectations early, and how clients may be demanding or erratic on occasion. ‘The whole team are involved in managing the patient so they are also aware of what to recognise as well as the pharmacist, can manage expectations and behaviours, so it doesn’t have an impact on other customers.’ In Mr Joynson’s experience, ‘this group of patients has posed no more of a challenge than any other in any pharmacy I have worked in. I put this down to making sure we approach and treat every patient the same; every patient must leave feeling cared for and respected,’ he says. Benefits of a supervised consumption service Summing up the value of delivering a supervised consumption service, he has also found that it has allowed him ‘to have some of the best and most meaningful consultations with pati