The National Institute for Health and Care Excellence’s (NICE) guideline NG5 — ‘Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes’ — sets recommendations around patient decision aids (PDAs) used in consultations involving medicines. Leeds Teaching Hospitals NHS Trust undertook a scoping exercise to determine whether these recommendations were practical for our trust to meet. We are aware that other trusts may be interested in our approach.
We undertook several activities to determine the feasibility of meeting these recommendations. First, we contacted specialist pharmacists to determine if any clinical area was routinely using PDAs. Understanding of PDAs was limited, and only one PDA was in occasional use: the NICE ‘Reducing the risk of stroke in atrial fibrillation’ PDA. We met with our arrhythmia specialist nurses, who also rarely use the atrial fibrillation PDA. In practice, the documents were found to be cumbersome, very long (at 36 pages) and unsuitable for a majority of patients. Clinicians found them to be difficult to use as part of a consultation. We also met with Hilary Bekker from the University of Leeds, whose specialist research area is PDAs. To her knowledge, no other trust had managed to make PDA use part of routine practice.
We identified currently available PDAs that meet the International Patient Decision Aid Standards criteria (as specified by NICE). There were 17 PDAs available nationally and additional online PDAs, directed to the US audience, which were deemed unsuitable for our patient population. Our Drug and Therapeutics Group determined that we should not develop our own PDAs owing to the intense process required for the development of patient information in the Trust. It was felt that if NICE set these guidelines nationally, the body should be providing PDAs for use.
We determined that routine use of PDAs was not feasible in practice owing to the lack of nationally available PDAs, and the difficulty of using these documents during patient consultations in practice. We have, however, made the national PDAs available on our medicines formulary, subject to annual review, for use with patients where deemed appropriate by the clinician. As part of ‘decision making’ training provided by the Leeds Medicines Advisory Service, we educate clinicians on the availability of PDAs.
I would be pleased to discuss further with any NHS trust that has progressed the use of PDAs.
Emily Turner, senior medicines advisory pharmacist, Leeds Teaching Hospitals NHS Trust