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ATHP calls for local collaborative networks and a seven-day service

By Gareth Malson, MRPharmS

Doc at computer

Electronic prescribing is being implemented too slowly by UK hospitals, says the Association of Teaching Hospital Pharmacists (Ben Blankenburg/iStockphoto.com)

The White Paper for pharmacy (entitled “Pharmacy in England”) is, in the words of the Association of Teaching Hospital Pharmacists, a blueprint for action for the pharmacy profession from the Government.

The association is “excited” by the opportunities outlined by the Government and recently published its response.

Summarised below, its response outlines the actions that will be taken by teaching hospitals in England to implement the Government’s plans. The response has a general theme of improving communication within the profession to enhance patient care, and members of the ATHP hope that pharmacy departments in all other hospitals in England will follow their lead.

Seven-day service

Hospital pharmacists can improve the patient experience and their overall care by managing the transfer of patient information relating to medicines, says the ATHP. This occurs through performing medicines reconciliation when patients are admitted to hospital and communicating with community pharmacists when patients are discharged.

However, to ensure quality patient care is delivered to all patients, the ATHP believes that hospital pharmacies will need to offer this service seven days a week.

Professional collaboration

The ATHP welcomed proposals concerning professional collaboration, both within the pharmacy family and between all professions involved in handling medicines. It believes that this is already occurring within UK hospitals through pharmacy involvement in multidisciplinary teams.

However, it will seek to obtain further local support for medicines management agendas by asking the national clinical director for hospital pharmacy (a role proposed in the White Paper for which recruitment is underway) to engage with leaders of other professions.

In addition, chief pharmacists at teaching hospitals will work with primary care colleagues to identify projects or changes to patient care that will have the greatest impact in their local areas. Such projects include:

  • Improved prescribing and monitoring of anticoagulants and disease-modifying antirheumatic drugs
  • Preoperative assessment clinics located in community pharmacies
  • Support for prescribing and supplying chemotherapeutic drugs in primary care
  • Increased prescribing and supply of homecare medicines

The ATHP also believes that a model of medicines supply, where community pharmacies are used to supply discharge medicines for patients, could be explored.

Consultant pharmacists with independent prescribing rights, who consult with patients in hospital clinics, could also run sessions in primary care, it suggests. These sessions would involve some direct patient care, but also provide training and support for community pharmacists.

The ATHP wishes to collaborate more effectively with the pharmaceutical industry to improve the supply of medicines (particularly injectables). The industry could reduce the workload of aseptic dispensing services by providing injectable medicines in a ready-to-administer form.

The ATHP says it will lead discussions with the industry to reach agreements about which products are required. 

Local professional networks

Leadership for improving the quality of patient care relating to medicines and medication safety should come from pharmacy, the ATHP argues. Professional networks must be created to allow pharmacists from primary and secondary care who work in the same geographical area to “get together”.

The ATHP suggests that involving pharmacists from large multiples (eg, Alliance Boots, Lloydspharmacy and supermarkets) when developing services can be “problematic because of perceived competition”. Nonetheless, it believes that new networks are needed and that such networks must involve service commissioners.

The formation of “health community clinical pharmacy teams” is proposed. Members of the ATHP will lead on developing such teams in their respective localities and they urge chief pharmacists at other trusts to do the same.

Technological advances

The ATHP believes the rate at which hospitals in the UK are currently implementing  electronic prescribing is too slow. All hospitals should be implementing e-prescribing because the electronic transfer of information, both within and between organisations, is essential for modernisation, it says.

Another technology that should be considered is the installation of robotics on individual wards. The ATHP’s vision for medicines supply involves barcode scanning of drugs issued to patients from ward-based dispensing robots. Such systems could receive their stock directly from pharmaceutical wholesalers according to orders generated remotely via wireless, handheld terminals.

The ATHP points out that modern systems are needed to transfer patient information relating to medicines between hospital-based and community-based pharmacists. This will allow the outcomes of clinical medication reviews undertaken by specialist hospital pharmacists to be passed on to community pharmacists, it says.

The latter will then be able to provide a greater level of care for patients post-discharge — possibly during medicines use reviews, it suggests. This would help community pharmacists to be more involved in ongoing patient care and reduce medicines waste.

While community pharmacies in Scotland are connected to the N3 network (formerly NHSnet), those in England and Wales are hugely disadvantaged by not being connected. This limits pharmacists’ access to community health guidance, shared care protocols, formularies and other tools that are essential for confirming the suitability of a prescribed medicine.

Solutions to this problem will need to be found locally. The ATHP believes this can be done more easily once local professional networks (as described above) have been established.

Healthy living centres

The White Paper highlighted the Government’s belief that community pharmacies should become “healthy living centres” by delivering several advanced or enhanced healthcare services as well as supplying prescription medicines. While some of these services are only suitable for community pharmacies, hospital pharmacies could offer some enhanced or advanced services.

ATHP proposes that if hospital pharmacies are adequately staffed, the following services could be offered:

  • Emergency contraception
  • Advice on the management of obesity and smoking cessation
  • Signposting for chlamydia screening services and vascular health checks

The ATHP believes that all hospital pharmacies should be conveniently located within hospitals and have consultation areas to allow confidential discussions with patients about their medicines and general health. However, it admits that this initiative will require substantial changes in facilities, hence considerable investment.

Staffing issues

Service provision in most hospital pharmacies is inhibited by staff vacancies. In its response, the ATHP says it will seek to work with NHS Employers to address this ongoing problem, possibly by enhancing training opportunities for staff or using the recruitment and retention premiums that are available via Agenda for Change.

The contribution made by Kieran Hand, consultant pharmacist for anti-infectives at Southampton University Hospitals NHS Trust, to reduce the incidence of Clostridium difficile infections is recognised in the response. Members of the ATHP will seek to appoint consultant pharmacists for antimicrobials in all of their hospitals. Chief pharmacists in all other UK hospitals should do the same, it advises.

The ATHP highlights that modernisation of hospital pharmacy services will depend on the whole pharmacy workforce, particularly pharmacy technicians. Capacity needs to be built into the pharmacy technician workforce and hospital pharmacy departments should investment in education and training schemes, it says.

Preregistration integration

Proposals in the White Paper to review the clinical content of the pharmacy degree and determine whether preregistration training and undergraduate studies could be integrated are supported by the ATHP. This will allow pharmacy undergraduates to “experience real life pharmacy practice, much as occurs in the medical education model”, it says.

ATHP members are excited by the prospect of pilots for such integrated training programmes and have expressed their wish to be involved. They will seek to establish links with nearby schools of pharmacy, although they warn that more involvement by clinical practitioners in undergraduate education will require additional funding.

Working with patients

The ATHP’s response also addresses working with patients. It indicates that when medicines for long-term conditions are first prescribed, patients need to understand why they should take them, the benefits of taking them continuously and whether there are any risks.

When treatment benefits are not understood, concordance is poor. The ATHP believes that patients must be given access to information about their medicines — such information could be individualised, web-based and accessible from pharmacies or patients’ own homes.

This initiative will require technological developments and will need hospital and community pharmacists to be involved, it says.

Research into public views about pharmacy practice and medicines handling in hospitals will help involve patients in decisions about how to develop pharmacy services. The ATHP welcomes the White Paper’s proposal of a national communications programme for patients and wishes to be closely involved with it.

Research

The ATHP supports the White Paper’s suggestion to appoint an expert panel to advise on priorities for health service research in pharmacy and wishes to be part of it. It believes that enhanced roles for pharmacists are necessary in pharmacovigilance as well as research into clinical practice and pharmacy service delivery.

Future research should determine:

  • The optimum way to supply medicines
  • How to make best use of the pharmacy workforce
  • How to work with patients and the public to re-engineer pharmacy services

Supporting the research agenda requires adherence to standards of good clinical practice during clinical trials. The ATHP wants to develop consultant pharmacist posts to lead this agenda, particularly for anticancer treatments.

Pharmacists employed in these posts should be the main investigators in clinical trials and should support biomedical research programmes, it stresses.

The ATHP also wishes to work more closely with the National Institute for Health Research and the pharmaceutical industry to find new ways of supporting patients’ access to new drug treatments within clinical trials and compassionate use programmes.

Gareth Malson is acting editor of Hospital Pharmacist. The Association of Teaching Hospital Pharmacists comprises the chief pharmacists and nominated deputies from hospitals formally linked to undergraduate or specialist postgraduate medical teaching trusts in the UK

Citation: Hospital Pharmacist URI: 10032446

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