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Pharmacists are being trained to work as prescribers in A&E, conference hears

Pharmacists in the West Midlands are being specially trained as independent prescribers so that they can manage patients in emergency departments, David Terry, deputy chief pharmacist at Birmingham Children’s Hospital, told participants at the 19th Congress of the European Association of Hospital Pharmacists this week.

Funding for 70 training places has been secured from Higher Education West Midlands so that pharmacists can be used as frontline clinicians, said Dr Terry. He explained that the shortage of doctors and nurses has become a “crisis” and so pharmacists are being asked to take a more hands on role with patients. The hospital is in phase 2 of a study on the initiative and initial results showed that pharmacists could deal with up to 60 per cent of patients who attend accident and emergency, said Dr Terry.

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Community pharmacists may also be included in the training, he added, so that they, too, can be brought into accident and emergency departments.

Innovation for children on long-term medication

Dr Terry was speaking on the subject of integrating hospital pharmacy into primary care and gave examples of other innovative practice at Birmingham Children’s Hospital, including a service that manages patients on long-term medication. The service made it to the final three projects in the NHS Innovation Challenge prize competition. He explained that over 1,000 children on long-term medication are managed by nine staff, including three pharmacists, two technicians, three data analysts and an efficiency expert. The staff deal with both outpatients and also directly with GPs who need help managing their patient’s long-term medication. Dr Terry said that the service is funded through the local clinical commissioning group, but that it more than pays for itself.

Patients can be referred to the service through the hospital’s onsite pharmacy, which is itself developing new ways to help patients. It was opened in February 2013 and is called “The medicines chest”. It is staffed by three paediatric clinical pharmacists and focuses on providing advice and support to young patients and their parents. Medicines for children often have to be specially prepared and so the pharmacy has commissioned its own range of unlicensed medicines, which Dr Terry said brings consistency and saves the hospital money. In addition, the pharmacy uses a robot in the dispensary to free staff so that they can spend time talking with patients. 

Extended prescription service

Finally, the hospital is also initiating an extended prescription service. Dr Terry said that paediatric patients often leave hospital with only a few days’ supply of medicines but it can take up to six weeks for a patient’s GP and hospital doctor to decide who is in charge of prescribing what medicine. So the hospital is changing the current policy to enable patients to receive three months of their medicines on discharge, he said.

Giving the Spanish perspective, Miguel Angel Calleja, head of pharmacy at Hospital Universitario Virgen de las Nieves in Granada, Spain, said that in his hospital patients with chronic conditions can be given a prescription for up to a year. This has reduced the number of doctors’ appointments these patients need, which has resulted in a 23 per cent reduction in visits to family practitioners and a reduction in the number of visits to community pharmacies, he revealed. A key enabler of joint working between hospital and primary care has been electronic patient records and electronic prescribing, he said. In his area of Spain, each patient consultation and pharmaceutical intervention can be electronically recorded and it is possible to track when a patient has picked up their medicine from the community pharmacy. Dr Calleja said working together has helped reduce the overall healthcare budget in the region.

The congress took place in Barcelona, Spain, from 26 to 28 March 2014.

Citation: The Pharmaceutical JournalURI: 11136616

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