To improve on previous arrangements for the provision of anti-virals for the prophylaxis of influenza in Care Homes during a confirmed outbreak, the Medicines Optimisation Team at NHS Devon CCG decided to approach community pharmacists to see if they could assist with a more efficient and timely supply process at weekends, and during the working week where GPs were unable to provide prophylaxis to residents. The process would still need to be clinically safe and be able to provide reassurance that should patients receiving prophylaxis become symptomatic, they would have appropriate assessment and subsequent treatment.
Working with the LPC it was decided that 5 community pharmacies across Devon would be commissioned to hold an agreed level of stock of oseltamivir and zanamivir and be ready to supply to a care home using patient group directions (PGD). During the working week, the MOT would facilitate provision of residents' renal function information to the community pharmacist in order for patients to receive the most appropriate drug and dose. On Friday evenings and Saturdays, the PGDs made provision for appropriate doses to be supplied without this information being readily available, as per PHE guidelines. Algorithms, SOPs and documents for communication between community pharmacists and GPs were written and supplied by the MOT.
Outcomes:
Fortunately, we found the service was not needed very often as the number of influenza outbreaks in care homes in Devon in 2019-20 was much lower than previous years. However, two care home outbreaks were dealt with over the Christmas period including one on Christmas Eve. The main achievement of the service was to remove pressure and workload from GPs over this period but still make an efficient and safe supply of prophylaxis to care home residents.
