This is my poster presentation that was accepted to Physiotherapy UK Conference 2019.

Introduction


COPD is the fourth leading cause of death in the world (WHO 2019) 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. 
With the national drive to provide more care at home, the number of community respiratory teams are increasing. In this Respiratory Team 3 clinicians have undertaken 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 referred from primary and secondary care agreed with their designated medical supervisor. However, there is very little research found available to ascertain non-medical prescribing habits within a community respiratory setting. 

This service evaluation aims to review actual prescriptions given versus the expected prescriptions between April and September 2018, we hypothesise that we will prescribe mostly inhaled therapy. 

Method

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


Results

In total 3 clinicians issued 56 prescriptions for 72 patients over a 6 month period, 50% of prescriptions were for inhalers with 15% antibiotics and 9% Saline (0.9%), Salbutamol nebules and antifungals for oral candida. The most inhaled therapy prescribed were as LAMA’s and the least was SABA’s.

Conclusion

The results confirm the majority of prescriptions were for inhaled therapy. Prescriber feedback confirms implementing therapy promptly has been invaluable to improve continuity of care. 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. 

References

World Health Organisation, 2019 <https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death>British Lung Foundation (2019) <https://www.blf.org.uk/>