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Urgent and emergency care

Pharmacists support emergency departments during winter pressure spike

Pharmacists are being asked to support emergency departments by issuing discharge prescriptions, reviewing patients and carrying out medicines reconciliation for newly admitted patients.

Accidents and emergency department

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Pharmacists are being asked to support emergency departments by issuing discharge prescriptions, reviewing patients and carrying out medicines reconciliation for newly admitted patients

Pharmacists are being called in to support emergency departments as winter pressures force tens of thousands of NHS elective operations and routine outpatient appointments to be postponed.

In some trusts, prescribing pharmacists are providing support in emergency departments by issuing discharge prescriptions, reviewing patients and carrying out medicines reconciliation for newly admitted patients.

“The expert skills of the pharmacist can also be utilised to undertake medicines-focused duties, such as pre-discharge medicines optimisation, medicines reconciliation and prescribing,” explained Stephen Whyte, clinical fellow in urgent and acute care in west London, and lead pharmacist for urgent and emergency care at Health Education England.

“During times of high activity, such as winter pressures, emergency department-based pharmacists can free up medical time and provide a quick turnaround for patients presenting with minor illness or injury, reducing the number of breaches of government targets.”

Hospital pharmacy departments have also been struck by the same rise in demand and are working overtime to support colleagues in the community to ensure that antibiotics and antivirals are readily available for at-risk patients, such as those over the age of 65 years.

“Our dispensary has experienced a surge in demand over the last few weeks — for the majority of this period our daily workload figures have been running at over 120% of what we were dealing with before the recent demand spike,” revealed James Allen, deputy chief pharmacist at University Hospital Southampton Foundation NHS Trust.

“It has also been a logistical challenge to ensure the relevant stocks of antibiotics and antivirals are available, alongside supporting our community colleagues in obtaining supplies for out-of-hospital patients with influenza, such as those in residential care homes.”

Allen added that a “large proportion of ward-based pharmacist teams” at his trust had “gone into overdrive” supporting medical and surgical teams, including support for the emergency department from a prescribing pharmacist.

Measures to deal with the current winter pressures were put forward by the National Emergency Pressures Panel, chaired by former NHS medical director Bruce Keogh, as part of the new NHS Winter Pressures Protocol.

The panel also reiterated the message from the Royal College of GPs (RCGP) that all patients should consider self-care, NHS choices or consulting with a pharmacist before seeking an appointment with their GP.

Allen said he could not recall a period in the last 10 years that has been busier than the situation being faced by hospital and community teams.

The Royal College of Emergency Medicine (RCEM) released a statement on 4 January 2018 calling planning for the current winter period “too little, too late”, and insisting that the “solution” of cancelling operations would cause further problems for those whose treatment was postponed.

“A&E departments are struggling — even in a week that traditionally experiences a lull from the pressures of winter. If this is better prepared, then it’s both a startling admission of the abject failure of planning in previous years and a poor reflection on the current plans,” said Chris Moulton, vice president of the RCEM.

“The NHS is in the grips of another winter crisis, as patients face long delays in care, operations are cancelled and staff find themselves working under extremely difficult circumstances,” said Anthea Mowat, representative body chair at the British Medical Association.

“What is happening in our A&Es is symptomatic of pressures across the entire system. Hospitals are at capacity, GP surgeries are full, and a shortage of social and community care means that many patients who no longer need to be in hospital can’t be discharged as there is simply nowhere for them to go,” she said, adding that politicians need to look again at NHS funding to ensure that the NHS has the staff and capacity needed to deal with the pressures it faces each year.

Figures released by the Scottish Government highlighted that the number of people suffering from flu in Scotland had more than doubled compared to the same time last year, while GP data released by the RCGP showed that more people are presenting to GPs with flu-like symptoms than earlier in 2017.

NHS figures released on 4 January 2018 showed that 16,900 patients faced waits of half an hour or longer in ambulances outside A&E in the week running up to 31 December 2017, 4,700 of which were over 60 minutes. In addition, there were 480,400 calls to NHS 111 in that same week — the highest number of calls in a seven days since the service was created.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204197

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