Publish date: 3 July 2024
May's Employee of the Month winner is Adeline Wong, Medicines Management Community Mental Health and Warrington Recovery Team, nominated by Angela Evans for the value of continuous improvement
"Adeline reviewed the Warrington CMHT caseload as Advanced Clinical Pharmacist and found some clients are prescribed medications above BNF limits (HDAT). Adeline was concerned that the benefits of this must outweigh the significant risks to physical health. Adeline recognised that this was often historic prescribing and that an approach to ‘total health’ and non-medication intervention may benefit some and allow a reduction of risks and improvement in mental and physical health. Adeline was new to her team and keen to develop into the role of community mental health pharmacist and improve outcomes for patients by exploring new approaches. Adeline in collaboration with her team began a complex prescribing forum. Adeline completes a medication review to identify the risks and rationale of the prescribing and then presents to the wider clinical team, ACP and medics. After rigorous MDT discussion, reflection on previous approaches, a plan is made with the client to reduce risks.
A man with epilepsy, hypertension, Type II diabetes and plaque psoriasis was historically prescribed 3 antipsychotics at 267% BNF limits for psychosis. Adeline took a full medication history and discussed with the complex prescribing forum newly set up in team. Clinical challenge and reflection by the forum identified potential changes to improve his total health. Adeline spoke to the client in person to explain options clearly and carefully. Adeline used the Choice and Medication resources to minimise complexity and ensure that the benefits and risks of each option were clearly understood. The dose of olanzapine was reduced, and he was followed up in clinic. There has been no worsening of his mental health, and he already feels clearer of mind with less brain fog and sedation. His HbA1c has also improved meaning that his diabetes is better controlled. Adeline plans to support him in optimising his medication and improving his total health in her clinic ongoing."
May's Team of the Month winner is Mitton Ward nominated by Emily Walmsley for the value of continuous improvement
"Service user on Mitton Ward is supported on his own corridor by the nursing team. This service user is in Long Term Segregation and with input from the MDT he has been supported to go from seclusion to a Long Term Segregation setting including his own bed space, living room and garden with periods of integration with his peers. The team have supported service user, and he now has regular community leave. The team supported service user to have blood tests without any restrictive intervention which have not been possible previously. The team are positive about service user and his future. The team have supported him to reduce his scorings on his barriers to change checklist and this has shown significant improvements in all areas. service user’s family have attended ward round and have commented on the excellent care he is receiving and said they have noticed his 'smile has come back' he is 'making jokes and making the family laugh again' and becoming himself again. The team show unconditional positive regard and care for this service user. Well done!
Differences made:
- Service user 's immediate team communicate well with his family and MDT making it more fluid to implement changes and improve patient centred care.
- He is happier and more stable and getting closer to looking at a future of living in the community. His family are happy currently with his care and treatment.
- The team feel safer and more knowledgeable about him and his needs. Improvements are being made.
- Excellent communication has meant service user's physical health can be monitored more closely and his care and treatment from full MDT can be implemented more fluidly.
- Service user's staff have great attitudes and confidence with him."