Introduction A multidisciplinary team (MDT) is essential to ensure high quality and compassionate care for patients with longterm diseases. We established a holistic care model using a MDT approach to provide support through easily accessible services and permeable pathways.
In addition to the medical/nursing staff a post for a pharmacist was incorporated into the team; this complemented and highlighted total integration of roles.
Multidisciplinary services are widely reported but having nursing/pharmacy staff sharing responsibility for patients care is innovative and new ways of working were explored in the redesigning of our IBD service.
Clear pathways were developed to ensure patients attended appropriate clinics and enabled reviews with the correct team member.
Therapeutic drug monitoring (TDM) was newly introduced to optimise medical treatment.
At the MDM pathways were developed to initiate and review immunomodulators and were facilitated by the nurse/pharmacist.
Results Established patients were seen for follow ups mainly by the nurse specialist. One pharmacist clinic was established weekly. Referrals to the pharmacist clinic consisted of patients needing to initiate and optimisation of immunomodulating therapies, adverse drug reactions (ADRs) or with perceived concordance issues. The nurse/pharmacist clinics are well used with 10 patients per clinic supporting the effectiveness of the new developed pathways.
Interdisciplinary support was provided to enable the nurse/pharmacy team to deputise for each other when answering the patient helpline/email queries and undertaking the TDM for patients on immunosuppressants. The helpline had an average of 11 calls per day. In the 4 months analysed 1032 calls were managed of which the pharmacist answered 142 queries whilst deputising.
Due to the involvement of the pharmacist early adoption of innovative TDM was established.47 patients had their immunosupressant therapy changed or stopped, resulting in a minimum of £50,000 savings in the initial 4 months.
The infusion clinic was expanded to include cross speciality patients on immunosuppressants, nutritional supplements and iron due to the involvement of the pharmacist guaranteeing effective support for non speciality patients.
The MDM reviewed 42 patients according to the developed pathways. 10 patients considered eligible for biologics/7 patients needed their therapy altered.
Conclusion Interprofessional relationships profit greatly when working closely and deputising for each other. Providing support for each other when taking over responsibility for non traditional roles proved to be an effective way of enhancing patient safety. Permeable pathways and standardisation of treatments including consistent monitoring provided sound governance for individualised medical care.
Disclosure of interest None Declared.
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