Impact of Remote Prescribing Consultations in Tertiary Care

ABSTRACT

Introduction COVID-19 has impacted the delivery of services provided throughout the National Health Service. Innovative ways of working remotely has been a challenge to provide safe and effective care to patients in a timely manner. The Gastroenterology and Nutrition Team at Birmingham Children's Hospital, treat one of the largest cohorts of paediatric patients in Europe with Inflammatory Bowel Disease, intestinal failure receiving home parental nutrition and other gastrointestinal diseases. Many patients are on long-term medication and the pandemic increased the demand for remote prescription requests. The Advanced Nurse Practitioner recognised and developed a service improvement initiative to prescribe safely through remote consultations. Aim To provide a standardised approach to provide remote consultations in order to issue repeat prescriptions in a safe and effective manner. To adhere to current guidance, to promote best practice, work in partnership with GPs and to audit the findings following implementation. Method Searches were conducted for literature surrounding remote prescribing. Using current guidance, the ANP implemented a seven step approach in performing prescribing consultations (see figure 1). Results 232 patients requested repeat prescriptions, with a total of 435 medications. These figures are from booked clinics and any requests outside of these were not included in these findings. Figure 2 outlines the outcome from implementing stage 5 of the process (figure 1). Combining the number of GPs who agreed to prescribe, with the agreed Clinical Commissioning Groups (CCG's) funding, amounted to 54.74%. 17 CILT funding requests are pending, therefore 60.06% of requests are likely to be funded. 40 patients (17.24%) were removed from the medication requests for a variety of reasons and 48 requests (20.68%) are pending a response. In 18 consultations, recommendations were needed to promote patient safety, for example . Unwell patient booked into a face to face clinic for review . Abnormal bloods - neutropenic (Azathioprine placed on hold) . Insufficient blood levels highlighted to consultant - increased medication dose/duration . Missed blood monitoring - arranged . Poor compliance - booked into Clinical Nurse Specialist clinic . Missed clinic appointments - booked in Summary By recognising and applying a new way of working has improved patient safety as it allows for a planned consultation to be completed in a timely assessment by an advanced practitioner. Auditing the process has reported that remote prescribing clinics have streamlined the process, provided accountability with clear documentation and facilitates working in collaboration with colleagues, all of which promote prescribing governance. This service improvement pathway has led to reducing drug costs within the department whilst generating income to the Trust, although figures are to be finalised. Conclusion It appears that from implementing a remote prescribing clinic, it has allowed a timely consultation to assess the patient, review investigations, identify evidence-based treatment options, present options and reach a shared decision. Working collaboratively with colleagues in primary care, by documenting and offering Effective Shared Care Agreements has developed patient care and reduced drug costs in the department. Many medications used in paediatrics are unlicensed. Where GPs have felt unable to prescribe in partnership with specialists, by offering paperwork to decline prescribing, has allowed the Gastroenterology Team work with the Commissioning Interface Liaison Team which has gained funding from the local CCG to cover the cost of supplying, dispensing and delivering the medication.