The Middlesex Pharmaceutical Group (MPG) of Local Pharmaceutical Committees (LPCs) was asked to make a pledge:
What promise could the MPG make (and keep) to help improve the health of patients with asthma, a reversible condition?
Let’s take a step back.
The MPG is the organisation responsible for LPCs across 9 boroughs of North Central and North West London. Each LPC represents the Community Pharmacies within its borough and helps those Pharmacies to navigate the Community Pharmacy NHS contract and provision of services. Another LPC role is to encourage education and training of the Pharmacy Practice healthcare teams. The MPG decided to direct its pledge towards training.
Patients with asthma are supposed to visit their GP for an asthma review at least once a year and this should include an inhaler technique check. Patients are also offered an annual medicine review at their regular Community Pharmacy. So why are so many patients still suffering or having a poor control of their asthma?
A discussion with Pharmacists together with healthcare professionals from other settings indicated a lack of confidence when reviewing respiratory patients. We decided to set up an inter-professional pilot Inhaler Technique Workshop in NCL, enlisting the help of award -winning trainer Darush Attar-Zadeh, Barnet CCG Respiratory Lead. Guided by the recommendations made in response to the NRAD report, and the fact that there are more than 120 inhaler devices available, our aim was to refresh existing knowledge, understand red flag signs of disease deterioration and become familiar with the devices. Surprised participants had the opportunity to watch demonstrations by Darush and try for themselves, understanding the breathing required for effective use of different categories of inhaler. Attendees left a lively training session, with two carrier bags of placebo devices and brains full of new information. The inter-professional nature of the event allowed discussions of the challenges faced in the different healthcare settings.
The successful pilot motivated the MPG to hold another workshop in NCL and two in NWL. In all approximately 120 healthcare professionals have participated in the workshops, the post workshop feedback being very positive. All attendees responded that the training was of value and had increased their knowledge and confidence in this area, allowing them to support their asthmatic patients more thoroughly.
Community Pharmacist comments after the Inhaler Technique Training Workshops:
“Thank you very much for organizing the Inhaler Technique Training evening. Despite practicing community pharmacy for many years and dispensing and counselling patients on inhaler use I found the training very useful and has inspired me to attempt to coach every patient who uses inhalers on a regular basis and check and improve their technique as necessary to get the most out of the medication.”
“I was able to go through the 7 steps yesterday with a patient newly prescribed a dry powder inhaler. I am hoping she will come back next week and let me know how she is getting on.”
“It was a great meeting (quite a lot to remember!) but I’m sure everyone will have gained confidence in inhaler technique and be able to support their patients more effectively now.”
“It was great to be able to handle the different devices, I feel more confident to show patients how to use them.”
“After the Inhaler Technique Training Workshop, I felt more confident to coach the patients.”
“Within a few days of attending the Inhaler Technique Training Session I had several opportunities to coach children who had come directly from urgent care. Within a short space of time the child had “forgotten” or the parent “already knew” how to use the inhaler. Without the intervention, each child would not have used the device correctly and no doubt would have paid another visit to urgent care due to ineffective treatment!”
Patient Comments:
“I have asthma and so I showed my young children how to use their inhalers. I thought I was using them correctly but apparently not and that must explain why my children were still using a lot of the blue inhaler. The Pharmacists taught us how to use them properly and now we all feel so much better!”
“After another visit to accident and emergency my local Pharmacist showed me how my 6 year old daughter should be using her inhaler and spacer. We hadn’t used the spacer because it’s big but now I understand why it’s important I will. That could be why she kept needing to go back to hospital.”
“My son was using his salbutamol inhaler every day so the Pharmacist explained why he should be using his brown inhaler and having this chat put my mind at rest that it was safe to use the steroid one regularly.”