Transforming Heart Failure Care: Pharmacist-Led Clinic Saves £70,000
The Pharmacist led Heart Failure clinic was a project undertaken in Barking & Dagenham for 6 months, by Wajid Qureshi and team. Faced with increasing workload, workforce, and capacity pressures, the project aimed to reduce the time required to titrate patients’ medications to the maximum tolerated dose. The key innovation was the introduction of a Senior Pharmacist to conduct dose titration clinics on behalf of NELFT.
A baseline audit was conducted, highlighting that the average time to reach the maximum tolerated dose was 6.3 weeks, including follow-up. For Entresto, the baseline was 12 weeks, as patients were referred to BHRUT for initiation and follow-up. To address this, clinical guidelines for Entresto were developed, enabling community cardiac services to initiate and review patients, after discussion at MDT, thus eliminating the need for BHRUT referrals.
Results of the Pharmacist-Led Clinic:
-
The time to achieve the titrated maximum dose improved to 4.7 weeks (25% improvement!)
-
23 clinics were held, with 35 patients discharged and 88 medications prescribed.
-
23 MDT meetings were attended, with 60 contributions/interventions (2.6 interventions per MDT).
-
High levels of patient satisfaction, with an average score of 9/10.
-
Pharmacist-initiated Entresto achieved titration in 2-3 weeks.
-
A quality and financial impact assessment showed total savings of £70,000 – based on assumption that patients who were fully titrated were classified as avoidance of hospital admission (£2.7K per patient), as failure to do so would have resulted in poor prognostic outcomes with high risk of hospital admission within the year.
In conclusion, the project was successful, securing funding for a dedicated pharmacist to work in BHR.
Reflections from Wajid Qureshi:
I thoroughly enjoyed the collaborative aspect of this project, working with various roles from the community cardiac service and outside traditional boundaries. The entire team was supportive, rewarding to see the successful outcome of the project, and working on development of a dedicated role in BHR, adding a unique skill set to the MDT. Conducting quality and financial impact assessments was crucial, and applying a structured methodology helped us understand the value of the additional skill set. The interest in this unique pharmacist role was overwhelming, with a Trust in Hertfordshire requesting details to develop a similar role in the community. Presenting our work at the Clinical Pharmacy Congress was a highlight, attracting interest from many across the country, and an international pharmacist from Dubai.
By significantly reducing the time to achieve the maximum tolerated dose of medications and introducing efficient clinical guidelines for Entresto initiation following MDT, the project has not only improved patient care but also achieved significant cost savings. Patient satisfaction was exceptionally high, reflecting the positive impact of the clinic on patient health and well-being. This project not only highlights the importance of pharmacist-led initiatives in improving healthcare outcomes but also demonstrates the value of integrating unique skill sets into the MDT for enhanced patient care.
You can watch a presentation of this project here.