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Pharmaceutical Care Awards

Inflammatory bowel patients benefit from independent prescriber interventions

A specialist pharmacist is now managing the biologics service for gastroenterology patients as part of a multidisciplinary team.

Anja St. Clair Jones describes her role as an independent prescriber for patients with inflammatory bowel disease

Source: Nadia Attura

Anja St Clair Jones describes her role as an independent prescriber for patients with inflammatory bowel disease

A pharmacist independent prescriber’s involvement in the care of patients with inflammatory bowel disease (IBD) has freed up senior doctors’ time and improved the safe monitoring of medicines in a secondary care setting.

The Pharmaceutical Care Awards 2014 finalist team described how lead pharmacist Anja St Clair-Jones was integrated into the multidisciplinary IBD service at Brighton and Sussex University Hospitals NHS Trust to address therapeutic issues.

“I was particularly proud because I found that the multidisciplinary team has really changed focus towards medicines optimisation, [becoming] more aware of what we can use and how best to use the therapies we have,” St Clair-Jones said at the awards event. Gastroenterologist Melissa Smith added that there has definitely been a change in the way the team works — patients now transfer seamlessly between staff members and the team is truly multidisciplinary.

Before St Clair-Jones joined the team, there were patients on expensive biologics who were not being actively managed because they had stopped coming to clinics, according to Smith. “All of that has completely changed because Anja has complete control over what’s going on — she’s got a database filled with all the patients on all the drugs,” she explained.

St Clair-Jones is now managing the biologics service and ensures the appropriate patients are brought back for review. She was originally seconded to the role because the post of IBD nurse specialist had been vacant for more than a year. “I felt that this was something pharmacists could do and from there it evolved,” St Clair-Jones explained. Her responsibilities initially included providing and managing the biologics infusion service, running blood monitoring for thiopurines and biologics, providing a telephone advice service for patients needing support and triaging patients who contacted the service with acute flares.

Some patients now ask specifically for her because they know they will get “the right information” about their medicines, Smith said.

Refining the remit

Although the consultants and nurses were keen to have a pharmacist on board, there was some difficulty establishing the remit of the role, Smith told the audience at the awards. “There was some duplication and not quite knowing how to integrate her at first,” she said. “Would we actually let her start the drug, or should we start it and let her monitor the blood tests afterwards?”

St Clair-Jones has helped to drive the team forward by breaking down the barrier around a pharmacist’s role and taking on whatever fits

Now that the team is confident the system is secure, St Clair-Jones’s role has expanded. “Today she’s doing the formal detailed counselling, initiating the drugs and doing the monitoring,” Smith told the audience. “She comes to all our weekly multidisciplinary team meetings — she invested a lot of time in developing those relationships and making sure we appreciate her expertise.”

Smith added that St Clair-Jones has helped to drive the team forward by “breaking down the barrier around a pharmacist’s role” and taking on whatever fits, without being concerned whether specific tasks are strictly within her job description.

What measurable impact has the role had? By making 12 interventions during therapeutic drug monitoring of the biologics, at least £50,000 was saved for the health economy. “This is something pharmacists are really good at, therapeutic drug monitoring, where we make such a difference because it individualises the therapy for the patient,” St. Clair-Jones said. Additionally, because of the service 138 patients did not need to see a senior medical practitioner, which helped to reduce waiting lists and lower the cost of outpatient visits.

Expanding the project

The team now hopes to expand the project into homecare and is preparing a business plan to ensure the continuation of the service. Questionnaires seeking feedback about the service will also be issued to patients.

St Clair-Jones explained that although local commissioners are interested in the project because of the cost savings, they are “not that keen on gain share”. The team therefore plans to monitor patients via virtual clinics. “I just feel this is such a benefit for the patient, I can’t wait for the commissioners to say they are going to fund it — I’ll just find another way to do it,” she asserted.

The team believes the service can be used in other clinical areas where disease-modifying drugs are used. “Obviously it translates to other IBD services but doing the exact same thing translates to other disease specialities, and the same issues exist everywhere in the community,” Smith said.

“It’s the multidisciplinary approach that’s really important,” St Clair-Jones emphasised. “I couldn’t do this on my own; it has to be as part of a multidisciplinary team.”

About the awards

The Pharmaceutical Care Awards 2014 were held on 19 June at the Royal Institution in London. The awards are run by The Pharmaceutical Journal and the Royal Pharmaceutical Society (RPS) and are supported by GlaxoSmithKline (GSK).

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065923

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