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TARGETED MURS

TARGETED MURS. BY AMIT PATEL. WHAT IS A TARGETED MUR (tMUR)?. Is one of the changes to the Community Pharmacy Contract that will be introduced from 1 st October 2011. It is NOT a new service – simply a change to the existing service.

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TARGETED MURS

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  1. TARGETED MURS BY AMIT PATEL

  2. WHAT IS A TARGETED MUR (tMUR)? • Is one of the changes to the Community Pharmacy Contract that will be introduced from 1st October 2011. • It is NOT a new service – simply a change to the existing service. • 50% of MURs to be delivered should be with pts from one of the 3 national target groups: pts with Respiratory disease; pts taking a high risk medicine (anticoagulants, antiplatelets, diuretics and NSAIDs); and pts recently discharged from hospital who have had changes made to their medicines while in hospital.

  3. WHY HAVE NATIONAL TARGET GROUPS BEEN INTRODUCED? • To improve pt’s knowledge and medicines use in order to reduce hospital admissions and waste. • To ensure that MURs are provided to those pts who will benefit most. • To provide commissioners with assurance that the MUR is a high quality, value for money service that benefits pts and demonstrates the value of pharmacy services. • Further national target groups will be identified after initial implementation.

  4. COMMUNICATING ABOUT tMURs • PSNC & NHS Employers will produce information for pts about changes to service. • NPA have produced a fact sheet for its members. • From 1ST October 2011, pts must give signed consent • Promote this new service locally – window display, leaflets and team skills

  5. PREPARATION FOR tMURs • Staff training – re: target groups • Engagement with pharmacy team = key to success • Pharmacist training – clinical skills update, CPPE, local workshops/training events • Review standard operating procedures • Engage with GP practices • Identify eligible pts from PMR

  6. IINTEGRATING WITH GP PRACTICES • To ensure tMURs deliver better outcomes for pts • Meet face to face to discuss how it will work locally – GPs and nurses can refer appropriate pts for an MUR • Discuss methods of communication – forms, feedback etc • Link MURs with QOF e.g. COPD/ASTHMA, • Link MURs with QIPP indicators

  7. 1. RESPIRATORY DISEASE • Use PMR to find pts who are prescribed 2 or more relievers per month • Look for pts who refuse to have their preventer inhaler dispensed • Look for pts who are prescribed a spacer device and renewal date expired • Look for pts prescribed a peak flow meter • Use support staff to alert the pharmacist when receiving Pxs for inhalers

  8. RESPIRATORY DISEASE • Asthma/ COPD control test to assess whether pts’ asthma/COPD is controlled • Inhaler technique e.g. Devices to assess inspiratory flow rate • Adherence – step down and oral hygiene • Healthy lifestyle e.g. Smoking cessation

  9. 2. HIGH RISK MEDICINES • Antiplatelets, anticoagulants, NSAIDS and diuretics account for over half of all medicines related hospital admissions • Check pts oral anticoagulation therapy book • NSAIDS – side effects, interactions and GI problems • Diuretics – non adherence, falls relating to hypotension and electrolyte disturbances • Antiplatelets – risk of GI bleeding and look at OTC aspirin sales

  10. 3. RECENTLY DISCHARGED • Lack of communication regarding discharges has led to £150 million medicines wastage • Discharges should be sent to community pharmacy as well as GPs within 24 hours • Work closely with GP staff who deal with discharges • Try to establish communication with secondary care

  11. FAQs • HOW MANY MEDICINES DO PTS NEED TO BE TAKING TO HAVE AN MUR? • More than one - except if the patient is prescribed a ‘high risk’ medicine. With the exception of prescription intervention MURs, the patient must have had their medicines dispensed at the pharmacy for the past 3 months. • IF I UNDERTAKE AN MUR WITH A PT IN ONE OF THE NATIONAL TARGET GROUPS, DO I NEED TO REVIEW ALL THEIR MEDICINES? • Yes, all the medicines that the pt is taking should be reviewed, NOT just the medicine related to the target area.

  12. FAQS • IF A PT IS ELIGIBLE FOR A POST-DISCHARGE MUR BUT HAS ALSO BEEN STARTED ON A NEW MEDICINE, SHOULD I UNDERTAKE AN MUR OR RECRUIT THE PT TO THE NEW MEDICINE SERVICE? • Pts may NOT access both services at the same time. If you have a pt who is eligible for both services, the pharmacist will need to use the information and make a professional judgement about which service would benefit the pt most. • If the pt has come in for a targeted MUR and then 3-4 weeks later comes in with a Px for a ‘new’ medicine, then the pharmacist can perform a NMS consultation.

  13. SUMMARY • Targeted MURs is one of the few changes made to the national pharmacy contract and will take effect from 1ST October 2011 • 50% of Murs should be from these target groups • Engagement with staff and GP practices is essential • Pharmacist and staff training

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