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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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targeted murs

TARGETED MURS

BY AMIT PATEL

what is a targeted mur tmur
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.
why have national target groups been introduced
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.
communicating about tmurs
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
preparation for tmurs
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
i integrating with gp practices
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
1 respiratory disease
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
respiratory disease
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
2 high risk medicines
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
3 recently discharged
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
slide11
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.
slide12
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.
summary
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