Lipid Optimisation – the role of a Pharmacy Technician
Pharmacy technicians have a dedicated skill set and knowledge base. This enables them to triage a patient list and make recommendations on treatment options (following all appropriate guidelines) while also considering other medications and conditions.
They provide the clinician with a detailed review of a patient’s current situation/medical history/medications/blood results etc.
The clinician uses this information to make an informed decision regarding the patient’s treatment options. This approach ensures the workforce are being used efficiently, and to the best of their ability and potential.
Uniformity and ability to replicate: We decided that to enable other pharmacy technicians to work in similar ways, in different geographical areas, we would develop a process map.
Collecting consistent information and working in a comparable way will highlight any disparities and differences across the ICS. We can learn from the differences, share, and implement any areas of good practice.
"I had very basic knowledge in lipids when starting this role, I was provided with links to educational materials on cholesterol, lipid lowering therapies and general Cardiovascular Disease (CVD), all of which have been a great help & I carried out a PrescQIPP lipid modification e-learning course which gave me a better understanding of all areas which would be reviewed during the Lipid Optimisation process."
CVD remains the leading cause of premature mortality in England, causing a quarter of all deaths in the UK*. Improving the treatment ….. such as high cholesterol, is a vital part of CVD prevention. As set out in the NHS Long Term Plan – CVD is the single biggest area where the NHS can save lives over the next 10 years. HEART UK
Pharmacy technicians work with clinicians to enable a more timely approach to decision making. Ensuring the patient receives the appropriate medications and treatment options, for lipid optimisation in secondary prevention patients.
Prior to this project, it was not standard practice for pharmacy technicians to work in this area. Identifying, prioritising, and triaging the patients can be time consuming, and not the best use of clinician time. If a pharmacy technician can undertake these initial stages, it releases clinician time and can speed up the process.
This project aimed to produce a standard best practice approach that can be shared and spread across primary care.
This project supports the reduction of health inequalities, by using existing staff and systems to identify patients at risk of a cardiac event. This was done using the new Clinical Digital Resource Collaborative (CDRC) software to identify at risk patients. Pharmacy technicians can then support teams to prioritise and identify patients who may need lipid optimisation.
Identified a cohort of ‘Secondary prevention’ patients (people who have already had a cardiac event/stroke etc.) using CDRC searches. Work ongoing to optimise the patient’s lipid lowering therapy, to help reduce the risk of further events.
Current workforce:
1 technician working 1 day in North of Tyne
2 technicians working 1 day each in South of Tyne
1 technician working 3 days in North Cumbria
Support from AHSN NENC CVD team, practice pharmacists, specialist nurses and CDRC team.
Regular Teams meetings to share learning, problems and successes.
Financial impact – reducing pharmacist / GP time as the pharmacy technician does the initial triage which results in a cost saving. By using the right people at the right time, we can release capacity within the system.
Patient impact – reduce the risk of further cardiac events/strokes.
In a five-month period at one GP surgery 326 patients were identified during a search. Of these:
219 were reviewed by a pharmacy technician.
173 referrals were made.
77 were potentially eligible for Inclisiran.
18 started Inclisiran.
59 had their statin amended.
35 had Ezetimibe recommended.
29 required no follow up or were at target.
This five-month period involved 19 days of pharmacy technician time, this is a cost saving of approximately £3500 compared to a pharmacist doing this work.
This project supports the NHS long term plan identifying patients via the lipid management pathway which will help to reduce the number of cardiovascular events in NENC.
Raised cholesterol does not cause any symptoms, and patients can be unaware that their cholesterol is high or creeping up. This project aims to help reduce cholesterol with medical therapies and healthy eating advice, but also raises awareness to the patient about their cholesterol ‘numbers’ to empower them to be more proactive.
Education to primary care staff on acceptable nonHDLc levels as published by North England Evaluation Lipid Intensification (NEELI) guidelines.
Relieving burden for primary care on understanding lipids when they have conflicting priorities.
This collaboration has been wholly dependent on the AHSN NENC and would not have proceeded without AHSN support, guidance, and funding. The CDRC software has been a crucial element of identifying at risk patients. Tracy Marshall, Project Manager spends 2 days per week on this initiative, further support is provided by Ben Mole on the CDRC elements.
A further pharmacy technician is joining the project in June 2023.
In discussion with colleague from South West AHSN in relation to identifying familial hypercholesterolemia patients.
Lessons learned:
- Testing of the searches in different practices is important – the same search, performed in different practices, has highlighted some disparities.
- Having access to, and knowledge of, all IT systems from the beginning e.g. as well as EMIS or SystmOne, beneficial to have ICE, Accurx, EPS tracker etc.
Processing mapping is a really simple yet effective way to demonstrate, teach and speed up a process. It’s also useful in identifying gaps/inefficiencies in the system.
* National Health Service (NHS). The NHS Long Term Plan. Available at: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf
The role of a Pharmacy Technician in the lipid optimisation project has been so rewarding & shown to be vital within our community. I started the project with basic knowledge of lipid lowering therapies. The vast knowledge I have gained from the project has made me feel confident and passionate about helping people receive the best lipid treatment for them. The training and support around me as a technician has allowed me to explore & learn the developing treatment options available. My role has assisted pharmacists & GPs - highlighting the importance of a pharmacy technician. I feel I’m actively making a difference to people’s lives. I'm proud to be a part of the lipid optimisation project