Reducing Harm in Communities
Take Home Naloxone (THN) training and provision across community pharmacies in NHS Fife – Improvement and Impact.
December 2024
Situation
As part of the aim to reduce drug deaths and associated harms across Scotland, the Changing Lives Report in 2022 recommended that all Community Pharmacies within Scotland should have the capability to supply Take Home Naloxone (THN) to people who use drugs, families and anyone likely to witness an opioid overdose.
As discussed in the HIS MAT Standards Pharmacy impact report, community pharmacies form a key point of access and engagement for individuals who also access drug and alcohol treatment and can act as an essential community-based resource. To support the availability and accessibility of THN, staff should receive training in overdose awareness as well as the provision of THN, to ensure a comprehensive understanding of the issue. From 30th October 2023, the Scottish Government and Community Pharmacy Scotland agreed to implement Emergency Access to supplies of naloxone across Scotland as a first step in the aim to have emergency holding and supply of THN in all community pharmacies.
A number of challenges are outlined below that have been identified in relation to the supply of THN across all community pharmacies in NHS Scotland.
· Appropriate funding
· Engagement from pharmacy contractors and their staff
· Time and capacity to train staff
· An operational IT system to process claims
These challenges were seen within NHS Fife, with engagement and uptake of the THN programme across community pharmacies at low levels compared to registrations. From the start of this year, however, NHS Fife deployed a Senior Pharmacy Technician for Substance Use and other pharmacy staff to achieve the following outcomes:
1. Ensure all pharmacies have Naloxone available for emergency use and staff are proficient in its use.
2. Increase the number of pharmacies that were able to supply THN to people who use drugs, families and anyone likely to witness an opioid overdose.
The deployment of this member of staff was made possible by funding commissioned by the Fife Alcohol and Drug Partnership, with their involvement in project planning and strategic commitment in valuing the contribution that pharmacy makes to reducing drug related harm.
Approach
A key first step was identified to improve engagement with the service by raising awareness across community pharmacies. This was undertaken in 2 phases:
Phase 1 - Hosting a webinar for pharmacy teams
Phase 2 – Undertaking unannounced drop-in visits to the pharmacies to discuss the benefits of taking part in the THN programme and then advising on how this would be set up. Unannounced visits proved to have the greatest impact, and this immediately led to an increase in registrations.
In supporting roll-out and monitoring, it was important to ensure the online NEO360 system access for registered pharmacies was fully updated to record the provision of and claims for Naloxone, as well as monitoring patient training. Having the platform correctly functioning was critical for accurate data collection and measurement.
The next step was for pharmacy staff to undertake the necessary training on overdose prevention and Naloxone administration. Provision of learning whilst sustaining the day-to-day operation of the pharmacy was critical to ensure there was no service disruption for the community. Training was therefore scheduled on days most convenient to staff and split into multiple sessions to avoid this.
The training itself was conducted collaboratively with Naloxone training specialists from the organisation With You, who facilitated the overdose awareness aspect of the training with pharmacy technicians ensuring proficiency with the NEO claims system. Components of the training included:
· Handling demonstration THN kits
· Training checklists for the dispensing of THN
· Processing mock claims on NEO
· Q&A to solidify learning
Training was undertaken in-person within the pharmacy to offer a collaborative space for staff to not only receive the necessary training, but to engage on wider matters including current trends and evidence in substance use disorder. Staff could also discuss and share best practices to allow training to evolve.
To help maintain overall uptake of THN, monthly email updates are provided to pharmacies by the Senior Technician giving details of activity for that month, figures for what pharmacies were most active, as well as any upcoming milestones.
Impact
The figures above highlight the increase in active participation in the programme since changes have been made. In total 300 staff members have been trained across 50 community pharmacies and statutory addiction services within NHS Fife. This has meant that from April to October 2024, over 167 Naloxone kits have been distributed by community pharmacies within Fife compared to just 54 for the whole of the previous financial year.
Within community pharmacies that have received training, so far there have been three recorded instances of staff intervening in overdose occurrences within the vicinity of the pharmacy. One such instance, where a member of staff responded to a patient experiencing a suspected overdose outside of the pharmacy, was accredited to the THN training. Following the correct training steps, they were able to confidently assess whether to administer the Naloxone, which in this instance was not necessary as the person was still responsive. Being familiar with the individual helped establish what substances and quantities they had taken, and they made sure to remain with them to await medical attention. The learning from this case has encouraged even further uptake of the THN programme across community pharmacies.
Success has also been achieved in raising awareness of the training with the friends/family and those who work closely with patients who are prescribed Opioid Substitution Therapy. Staff reinforce that Naloxone cannot be self-administered, in order to encourage as many people as possible to undertake the training. There have been many instances of training being offered to those providing services to people at risk of harm alongside carers, both reflecting this was the first time such training was offered.
Next steps
The success in engagement and availability of THN supports the community-based responses in reducing harm. To maximise the impact that this has, there is an opportunity to expand from pharmacies into GP practice and other community-based health services for training and provision of naloxone for emergency response, particularly where there is a high prevalence of people at risk. Similar conversations have also emerged with community hospital staff in addition to primary care staff.
Lastly, there is a need to ensure sustainable funding for such programmes for naloxone and wider harm reduction to help reduce Fife’s drug related deaths.