{"id":2421,"date":"2024-08-14T10:41:59","date_gmt":"2024-08-14T10:41:59","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjsrh\/?p=2421"},"modified":"2024-08-18T12:06:56","modified_gmt":"2024-08-18T12:06:56","slug":"at-home-abortion-pack","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjsrh\/2024\/08\/14\/at-home-abortion-pack\/","title":{"rendered":"Creating a consolidated EMAH (Early Medical Abortion at Home) medication pack: What has the impact been?"},"content":{"rendered":"<p style=\"text-align: right\">By Nathan Burley<\/p>\n<p>&nbsp;<\/p>\n<p><b><span data-contrast=\"auto\">Background<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Up to seven medicines are provided for an early medical abortion, similar to the amount supplied after a heart attack. Abortifacients, analgesia, an anti-emetic, contraception and an antibiotic could be supplied, with each attendance resulting in at least four packs being given. Clinics providing this service may store a variety of different medications, with staff time spent ordering, receipting, storing, stock rotating, and bagging up the packs. Service demand for abortion care <\/span><a href=\"https:\/\/publichealthscotland.scot\/publications\/termination-of-pregnancy-statistics\/termination-of-pregnancy-statistics-year-ending-december-2022\/\"><span data-contrast=\"none\">has risen sharply post Covid-19 pandemic in Scotland<\/span><\/a><span data-contrast=\"auto\">. Our team proposed consolidating the most frequently used packs into one bag, delivered to the clinic pre-assembled and labelled, greatly simplifying the process.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Creation of the pack<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A <\/span><a href=\"https:\/\/www.sps.nhs.uk\/wp-content\/uploads\/2020\/11\/Guidance-on-Overlabelling-Repacking.pdf\"><span data-contrast=\"none\">strict limit<\/span><\/a><span data-contrast=\"auto\"> to the amount of medicines that can be re-labelled or repackaged by end users is in place in the UK. Individual dispensing and labelling for a patient can be done under the supervision of a pharmacist. However, dedicated units possess licenses that allow for \u201cpacking down\u201d and over-labelling of medicines in high volumes. We commissioned NHS Scotland\u2019s Pharmaceutical Specials Service to provide Early Medical Abortion at Home (EMAH) packs that contained the following four medicines (see figure 1):<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p style=\"text-align: center\"><span data-contrast=\"auto\">Cyclizine 50mg x 3 tablets<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p style=\"text-align: center\"><span data-contrast=\"auto\">Dihydrocodeine 30mg x 5 tablets<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p style=\"text-align: center\"><span data-contrast=\"auto\">Mifepristone 200mg x 1 tablet<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p style=\"text-align: center\"><span data-contrast=\"auto\">Misoprostol 200micrograms x 6 tablets<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:2,&quot;335551620&quot;:2,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">In addition to the medicines, the pack also contains a curated leaflet\/information sheet with additional instructions and contact information for the clinic. Leaflets\/information sheets can be tailored to each abortion clinic as this pack is now in use within multiple health systems in Scotland.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-ccp-props=\"{&quot;134245418&quot;:true,&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\"> <a href=\"https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-large wp-image-2422\" src=\"https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents-943x1024.jpg\" alt=\"\" width=\"640\" height=\"695\" srcset=\"https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents-943x1024.jpg 943w, https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents-276x300.jpg 276w, https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents-768x834.jpg 768w, https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents-1415x1536.jpg 1415w, https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents-1887x2048.jpg 1887w, https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents-640x695.jpg 640w, https:\/\/blogs.bmj.com\/bmjsrh\/files\/2024\/08\/EMAH-Pack-Contents.jpg 1920w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/a><\/span><\/p>\n<p><span data-contrast=\"auto\">Figure <\/span><span data-contrast=\"auto\">1<\/span><span data-contrast=\"auto\">. The contents of the commissioned EMAH pack displayed (without leaflet).<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">What have the benefits been?<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The main benefits have been simplification of medicines handling processes and staff time saved. We estimate that <\/span><span data-contrast=\"auto\">senior medical clinician time saved is approximately 97.5 hours or 2.6 working weeks over a period of 9 months.<\/span> <span data-contrast=\"auto\">Time saved per consultation is approximately 5 minutes. This has resulted in a total of 149 hours of clinical nursing and medical time saved which equates to around 4 working weeks for one member of staff. A single line-item in the prescribing system in use also saves medical staff documentation time.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Additionally, because the pack is standardised, the offering of cyclizine (an antiemetic) and dihydrocodeine (a moderate painkiller) is available for patients where the pack is in use. Historically boards would provide a myriad of options with some abortion clinics in Scotland providing no antiemetic or analgesia.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Finally there is a saving of accumulation of pharmaceutical waste or leftovers in patient homes. Pharmaceutical waste is costly to dispose of, <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36497873\/\"><span data-contrast=\"none\">presents a risk to the environment<\/span><\/a><span data-contrast=\"auto\">, and can lead to patients using medicines to self-treat where inappropriate.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">What are the downsides?<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The pack contents, for this iteration, have been set and agreed upon by a small working group and for production purposes constituent medicines have been locked in place with no variation. However, a second version is planned with wider stakeholders based on patient feedback and clinical experience with the EMAH pack as it stands.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Negotiating commissioning packs of this nature can be complex and early involvement of a specialist pharmacist was key to the success.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The boxes are all white which could be difficult to differentiate for patients. Additionally, dihydrocodeine may not be suitable for all patients, so the pack is only used in around 70-80% of all consultations. This necessitates individual constituent packs still being present in the abortion clinic with all the usual medicines handling tasks surrounding this storage.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The pack is an item procured from one supplier. The supplier is regularly kept up to date with anticipated demand so that packs can be manufactured accordingly. However, in the event of miscommunication regarding order volumes and quantities, supply can be interrupted with the resulting impact of falling back to making up packs manually.\u00a0<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Summary<\/span><\/b><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The introduction of the pack has brought a considerable amount of time savings to the staff in the clinic and conferred a degree of equity for patients accessing a suitable antiemetic and analgesia for abortion across the country (where used). Patients are given precise quantities so pharmaceutical waste is reduced. There are considerations to account for before adopting a similar approach, but if mitigated sufficiently, there are benefits for both staff and patients.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<hr \/>\n<p><strong>About the Author<\/strong><\/p>\n<div data-ogsc=\"black\">Nathan currently works as an advanced pharmacist in public health and sexual health in NHS Greater Glasgow and Clyde. This involves providing pharmaceutical knowledge and advice within the areas of public health protection, genito-urinary medicine, sexual and reproductive health, gender care, and abortion services. With a background in hospital pharmacy, he provides clinical input to complex patient cases and is responsible for ensuring services run smoothly and efficiently when it comes to medicines usage. He is a visiting lecturer at the University of Strathclyde and former president of the Guild of Healthcare Pharmacists.<\/div>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Nathan Burley &nbsp; Background\u00a0 Up to seven medicines are provided for an early medical abortion, similar to the amount supplied after a heart attack. Abortifacients, analgesia, an anti-emetic, contraception and an antibiotic could be supplied, with each attendance resulting in at least four packs being given. Clinics providing this service may store a variety [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2024\/08\/14\/at-home-abortion-pack\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":472,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[599],"tags":[],"class_list":["post-2421","post","type-post","status-publish","format-standard","hentry","category-screening"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Creating a consolidated EMAH (Early Medical Abortion at Home) medication pack: What has the impact been? - BMJ Sexual &amp; Reproductive Health blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2024\/08\/14\/at-home-abortion-pack\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Creating a consolidated EMAH (Early Medical Abortion at Home) medication pack: What has the impact been? - BMJ Sexual &amp; Reproductive Health blog\" \/>\n<meta property=\"og:description\" content=\"By Nathan Burley &nbsp; Background\u00a0 Up to seven medicines are provided for an early medical abortion, similar to the amount supplied after a heart attack. 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Abortifacients, analgesia, an anti-emetic, contraception and an antibiotic could be supplied, with each attendance resulting in at least four packs being given. 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