Developing and Utilizing CHD Resources Dr Irene Fruzynski Reynolds Road Medical Centre, Applecross Practice Background 8 GPs ( 5 FTE) 3 nurses (1 per day) Fully computerized – Med Director Mixed billing Fairly young practice – 4 yrs old Includes skin clinic Wave 1 Experience Dr Irene as „driver‟ Practice Principal in „backseat‟ 3 different staff at workshops Staff turnover issues Change Principle 2 Be systematic and proactive in managing care: PDSA cycle on CHD management principles Obtained NHF guidelines – incorporates NPCC aims but also others Distribute to doctors and continue to remind Keep handy Change Principle 3 Involve patients in delivering and developing care: PDSA cycle on Acute Chest Pain Management Review of existing protocols, review by doctors, endorsement, distribution to patients via doctors rather than mailout. Incorporate into GPMPs Change Principle 4 Develop effective links with key local partners PDSA cycle on devising database of Allied Health Professionals Nurse developed list from GP knowledge, Yellow Pages and Division website Check if registered with Medicare Plus Keep adding to list as new AHPs establish Change Principle 4 and 5 Develop effective links with key local partners and analyse your secondary care interface: PDSA cycle on available local physical activity resources Division happened to be researching this at the time Laminated A4 resource brochure adopted for each room Utilizing HMRs: Item 900 Change Principle 5 CHD patients are ideal candidates. Optimizes medication regime, better care of patients in the community There is a range of risk factors for medication misadventure HMR criteria There is only one criterion for a patient to receive an HMR. The GP thinks that the patient (who is living in the community) would benefit from this service HMR 10 Point Process 2. GP\Patient 3. GP 1. Potential consultation initiates HMR patient and informed HMR with identified consent patient 4. Sends 5. Pharmacy makes referral to appointment - patient’s chosen community interviews patient pharmacy and conducts Home Medicines Review HMR 10 Point Process 7. Two way 8. Consultation 6. Pharmacist with patient communication using sends report to between pharmacist’s GP report to pharmacist and GP complete medication review 9. Copy of action and plan to patient, 10. Claim: community pharmacy and inpatient notes Item 900 Alternative ways of doing HMRs By hand Electronically - eg Medical Director Combination (letter/fax) Some tasks can be delegated eg to practice nurse Medical Director Process As easy as 1, 2, 3 1. Click the Letter Writer on the MD toolbar 2. File menu - Choose “New” 3. Click the Template: eg “HMR Referral Template” 1 - Click the “Letter Writer” icon on the MD toolbar 2- Click „file‟ – „new‟ (or use „Ctrl+N‟) 3 - Click the Template or use the „supplied‟ template 4 - Click or type the Pharmacist 5 - Click “Progress Notes” you wish to include 1 2 3 6 - Click “Investigations” for inclusion 1 2 7 – Type/select in the minimum data set The referral is 95% complete Complete HMR referral Simply fill in any extra box It is not necessary to keep a hard copy Send copy to pharmacist Email (from MD) – if you have encryption Fax Letter Patient doesn't need to sign Click email and send (if secure in md3) or print - then fax/letter Completing the plan Second consultation; GP cannot claim item 900 until plan has been completed: Take time to gain informed consent and produce the referral or the plan cannot be claimed as consultation time; On receipt of pharmacy advice Use Letter Writer “Action Plan” Template - then follow the same process as for the referral HMR example Mrs KL 81 yo, PH CABG, Atrial fib, Diabetes type 2-diet Problem – multiple medications and INR fluctuating Pharmacist identified intermittent use of glucosamine, possible missed doses and highlighted risk of myopathy with statins with increasing age Action and plan Regulate dose of glucosamine, continue only if helpful after adequate trial. Monitor INR closely Organize webster pack Reduce statin from 40mg to 20mg as present chol <4 and monitor response Future PDSA cycles Identify CHD patients needing HMRs Nurse led clinics Questions?
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