SETTING UP OF A HOMECARE SYSTEM FOR HIGH COST NEBULISERS IN A PAEDIATRIC CYSTIC FIBROSIS CENTRE
Authors: Chorro-Mari Veronica , Christiansen Nanna 
Published: August 2016

Aim

Due to national changes to the commissioning process of high cost nebulisers (HCN) for Cystic Fibrosis (CF) patients, CF centres have to repatriate the prescribing of the HCN to the tertiary care centres.1 The following nebulisers will no longer be prescribed by primary care: Cayston® (Aztreonam); Colomycin®, Pomixin®, Clobreathe® (Colistimethate); Pulmozyme® (Dornase alfa); Tobi®, Tobi Podhaler ®, Bramitob® (Tobramycin).

This abstract explains how the Royal London Hospital (RLH) Paediatric Pharmacy recruited over 100 paediatric (CF) patients smoothly within a period of 4 months and set up a homecare system to avoid patients and families having to travel large distances to obtain their medication.

Methods

A number of homecare companies were evaluated initially. Parameters looked at were reports of customer satisfaction, delivery cost, turn-around time once the prescription was received and availability of same day delivery service.

In order to capture existing patients we met with CF Specialist Nurses to establish the total number of patients on HCN, what nebulised treatment they were on and their respective doses. We prioritised patients that had known problems with GP prescribing and anybody newly starting on HCN.

To communicate the change to parents, a letter was sent to all parents explaining the changeover to homecare delivery and tertiary prescribing. In addition a section in the parent bulletin was dedicated to the topic as well. Following this we contacted parents via phone and in clinic to request consent and explain the process.

Up to 10 patients were contacted weekly (average of 7); the consent form and registration form were then faxed to the Homecare company for patient registration. In parallel to this prescriptions were requested for the patients that had been set up in the previous week, ensuring that prescribing was spread out over time to avoid having peak times for repeat prescriptions.

In addition to the letter to parents GP surgeries were also informed in writing about the changes in commissioning and planned repatriation of HCN. This information was also included on discharge prescriptions for patients on any of the HCNs as part of the pharmacy screening process.

A system for follow up prescriptions as repeat was set up between the team so we would not have unexpected urgent requests and we could avoid missed doses, urgent delivery charge or stress in the team. In order to manage the prescriptions and ease communication across the team a database was developed.

Results

From March to July 2014 (16 weeks) one hundred and four patients were successfully repatriated to tertiary care.

Conclusion

A planned method and agreed standard operation procedure was key to effectively capture and repatriate all patients while at the same time keeping the increase on workload for the pharmacy team to a minimum. The fact of having a strong pharmacy presence as part of the multidisciplinary team attending CF clinics and ward rounds was vital in making this work.