flex Parkinson s disease Learning portfolio medicines optimisation learning for healthcare professionals

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1 flex medicines optimisation learning for healthcare professionals Learning portfolio WTM0214/1 March 2013

2 Learning with CPPE The Centre for Pharmacy Postgraduate Education (CPPE) offers a wide range of learning opportunities for the pharmacy workforce. We are based in the University of Manchester s School of Pharmacy and Pharmaceutical Sciences and are funded by the Department of Health to provide continuing education for practising pharmacists and pharmacy technicians providing NHS services in England. For further information about our portfolio, visit: Acknowledgements CPPE programme manager and author Ceinwen Mannall, regional manager, CPPE Content contributors Shelley Jones, clinical pharmacy team leader, neurosciences, King s College Hospital NHS Foundation Trust Karen Kite, lead pharmacist medicine, South Warwickshire NHS Foundation Trust Reviewers Maria Bell, regional manager, CPPE Annett Blochberger, lead pharmacist, neurosciences, St George s Healthcare NHS Trust Daiga Heisters, head of professional engagement and education, Parkinson s UK Design meeting Wei Chua, Registrar, Nottingham University Hospitals NHS Trust Arifa Ebrahim, clinical pharmacist, University Hospitals of Leicester NHS Trust James Fitzpatrick, clinical pharmacist, Royal Derby Hospital Sam Mitchelson, pharmacy technician, University Hospitals of Leicester NHS Trust Jeremy Robson, clinical pharmacist, stroke and neurology, Leeds Teaching Hospitals NHS Trust Alice Su, clinical pharmacist, Chesterfield Royal Hospital Editor Isabel Dennis, Outset Publishing Limited Thanks Sincere thanks to Tina Walker, Parkinson s UK, who kindly contributed her perspective of living with Parkinson s. This programme was piloted at Leeds Teaching Hospitals NHS Trust by Jeremy Robson, clinical pharmacist, stroke and neurology, and at Chesterfield Royal Hospital by Christa Lawson, principal pharmacist, clinical services. We appreciate their feedback and that of the participants in the pilot sessions. CPPE acknowledges the following brand names and registered trademarks which are mentioned in this programme: Half Sinemet, Laxido Orange, Madopar, Sinemet CR, Sinemet Plus, Stalevov All web links were accessed on 18 March Production Peacock Design & Print Limited. Published in March 2013 by the Centre for Pharmacy Postgraduate Education, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Oxford Road, Manchester M13 9PT.

3 flex About this flex programme The overall aim of this flex programme on is to support pharmacy teams and other healthcare professionals in advancing their knowledge and skills in relation to the management of Parkinson s in the acute setting. (Throughout this programme we will mirror Parkinson s UK approach by referring to this condition as Parkinson s.) The programme builds on knowledge gained from reading the Clinical Pharmacist articles, considering key national and local guidance and the views of patients and their carers. In the case studies you will consider how to manage the symptoms of Parkinson s symptoms for a patient undergoing surgery and consider the issues for medicines optimisation when patients are admitted to hospital unexpectedly. In addition, you will have an opportunity to extend or refresh your knowledge of the adverse effects of Parkinson s medicines and the importance of effective management of non-motor symptoms. Learning objectives On completion of this learning programme, you should be able to: describe the diagnosis and pathophysiology of Parkinson s differentiate between the motor and non-motor symptoms of Parkinson s explain the administration options available for a person with Parkinson s who is undergoing surgery, or unable to use oral medicines understand the importance of giving Parkinson s medicines on time, at the correct dose, and describe the consequences of missed doses demonstrate an understanding of adverse drug reactions, common interactions and drugs to be avoided in Parkinson s recognise the non-motor symptoms of Parkinson s and consider prescribing and management issues appreciate the roles of the multidisciplinary team, patients and carers in the management of Parkinson s know where to signpost patients, carers and professionals to for advice and education on Parkinson s. 1

4 This learning programme will provide you with evidence of learning for the following dimensions of the NHS Knowledge and Skills Framework: Communication Health and wellbeing HWB 1 promotion of health and wellbeing and prevention of adverse effects to health and wellbeing Health and wellbeing HWB 7 - interventions and treatments relating to the structure and function of physiological and psychological systems Level 3 Develop and maintain communication with people about difficult matters and/or in difficult situations Level 2 Developing self Level 3 Developing self and contributing to development of others It will also provide you with evidence for the following General Level Framework competency clusters: Delivery of patient care Professional Problem solving Gathering information Drug specific issues Patient education Team work Problem identification Knowledge Analysing information Analysis and recommendations Relevant patient background Drug selection Checking of dose, frequency, timing, route and duration Patient is counselled on medication Need for information identified Pharmacy team Multidisciplinary team Identification of drug-related problems Pathophysiology Side-effects and monitoring Interactions Appraises options Information provision to other healthcare professionals 2

5 flex About this learning portfolio We have developed this learning portfolio as part of the flex programme on. The learning and activities in the flex series will help you to think about changing your practice and demonstrate your continued fitness to practise. If you are facilitating this programme for a learning@lunch or learning community group, please access the facilitator s guide from the CPPE website: or: Case studies When you are on the ward reviewing patients you have access to many different sources of information about the patient and their clinical condition. In the case studies that follow, we give you the key points about each patient and you should make a decision based on these points alone. The cases are designed to illustrate some of the challenges involved in the management of Parkinson s and encourage you to discuss solutions with your colleagues. 3

6 It is agreed that this is adequate information to confirm Mildred s Parkinson s medicines and that a second reliable source of medicines reconciliation can be obtained when the GP surgery opens tomorrow. The nurses are unable to identify tablets to give safely from the dosette box, and do not have stock on the ward, so an order is raised from the pharmacy. The medicines arrive on the ward at 4pm, by which time Mildred has become quite distressed. She explains to the nurse that she usually takes her Stalevo at 2pm and 6pm. 2. What strategies could be employed to prevent missed doses in the future? 3. What are the potential consequences for the patient and the hospital trust when doses are missed? 8

7 The ward staff report Mrs Brown is concerned about her husband and wants to ask some questions about his medicines. Mrs Brown confides that she was concerned about her husband prior to this admission. He had started getting up for long periods during the night and used the computer. Now she has discovered that unexpected payments have debited their bank account and the computer browsing history includes internet gambling sites. 4. How do you explain Frederick s behaviour and what action would you take? 5. How would you respond to Mrs Brown? 12