The entire dynamic of pharmacy shifted last month when the Department announced its pre-orchestrated attempts to reform the Minor Ailments Scheme. Contractors, backed by the Ulster Chemists’ Association (UCA) and the Pharmaceutical Contractors’ Committee (PCC), withdrew from the service en masse much to the Department’s pr...
With high blood pressure thought to affect as many as one in five people in Northern Ireland, thousands of people throughout the country could be suffering from the condition without realising it. Gordons Chemists have made blood pressure testing a priority for their health promotion strategy, introducing free testing events at ...
| Hospital's Bright Future |
 |
 |
 |
| Written by Laure James - Editor Pharmacy in Focus | |
| Monday, 04 August 2008 11:13 | |
|
Battling to gain recognition and appreciation from other healthcare professionals as well as opportunities within health and social care have long been suffered by pharmacists, with the valuable work carried out in the community often overlooked by the Department and other clinicians. Pharmacists working within a hospital setting also face similar difficulties, particularly since their work is often far less publicised within the public domain. However, from revolutionising medicines management for visually impaired patients to encouraging pharmacists to report adverse drug reactions; and that’s just among the students. Five talented and ambitious pre-registration trainees from across Northern Ireland presented on individual projects to an esteemed delegation at NICPLD in Belfast last month, to mark the end of their year in practice and the beginning of their new career. Each had not only researched key areas of interest within hospital pharmacy practice, often combining examination of matters clinical and legislative, but were competing for the prestigious prize of attendance and presentation of their project at the UCKPA Winter Symposium in November 2008, kindly funded by Howard Tebby of Pfizer Ltd. Emer Gibbons, pre-reg at Craigavon Area Hospital, discussed the impact of introducing additional pharmacists in the Medical Admissions Unit (MAU) upon medication reconciliation targets, a department traditionally plagued by a very high workload. “My aim was to ensure that 95 per cent of patients would have their medications reconciled in the MAU within 24 hours of their admission,” Emer explained. “A baseline audit was conducted earlier this year, for one week during June. I produced a generic recording form which was distributed to pharmacists on each ward and designed for them to record the number of drug histories that required completion each day, with a note of how many they had managed to carry out.” Pharmacists were also asked to record the number of drug histories that had required intervention, which revealed some key findings. “During the following week, a re-audit was conducted, which involved the addition of three or sometimes four pharmacists to MAU for one hour each morning, with the same recording procedures observed as previously,” Emer added. “The percentage of medicines reconciled in MAU rose from 82.4 per cent to 91.2 per cent and importantly, there was also an increase in the number of interventions identified, rising from 53 to 59 per cent.” The benefit to other wards was evident, with an average fall in the number of drug histories carried out elsewhere, of 49 per cent. “One of the most beneficial aspects of this study, aside from the advantages for other wards and patient safety and medicines compliance, was giving those extra pharmacists, who were often supervised juniors, the opportunity to work in a new area,” Emer concluded. “I have received some very positive feedback from other practitioners within the hospital, especially those who allowed their pharmacists to help during the second week, who described the loss of a pharmacist for one hour was more than compensated for in the reduction of histories they had to complete.” Collette Lynch, from Altnagelvin Hospital, examined the existing protocol and provisions for visually impaired patients when it came to understanding and correctly administering their medication, and how this could be improved. Following a thoughtful and detailed approach to prior consultation with organisations such as the RNIB, lead clinical and specialist pharmacists, a consultant ophthalmologist and patients, Collette soon catalogued areas which could be improved. “The need for this work was highlighted both by the Audit Commission Medicines Management Audit and through discussion at the Trust’s Patient Forums,” she explained. “The main objectives were to improve the labelling for eye drops and to produce a new eye drop dosing information card, and to produce larger font patient information leaflets.” Collette devised larger labels, attached as flags to the side of eye drop bottles, medication cards and an SOP to achieve these improvements and also worked on increasing the awareness of healthcare professionals and visually impaired patients of the resource provided by the ABPI, X-PIL. This service, which has been available since April 2007, was developed to make patient information leaflets (PILs) accessible to the visually impaired. On the X-PIL website PILs are available in large text and in a format that can be used by a screen reader. Colette explained that not all medicine’s PILs were available on this site, but that she had discovered that if the patient or healthcare professional contacted the manufacturers of the medicine, a PIL would be developed for the patient in an appropriate format. Feedback from all involved was very positive, particularly since patients had raised previous concerns about their medicines. Nurses from Altnagelvin are already keen that the Pharmacy department at Altnagelvin should produce similar information cards for other eye drop formulations. Although introduced to alleviate pressures within the dispensary, the Extended Working Hours (EWH) pharmacy service at Antrim Hospital has been misunderstood and misused, as pre-reg David McCann discovered. “I evaluated the EWH service provision over an eight month period and discovered that although the EWH was largely well appreciated, particular wards had claimed to be dissatisfied,” David explained. “To ascertain why this was, I compiled a detailed analysis about which types of requests were being made to the EWH and it emerged that although the majority of requests were for discharge prescriptions, a concerning 13 per cent of all requests were inappropriate.” According to David’s research, this was due to a perennial confusion between the EWH and the Emergency Duty service, a separate function. He identified a need to better promote the EWH throughout the hospital and its valuable work. Operated by the MHRA and the Commission on Human Medicines (CHM), the Yellow Card Scheme, designed to promote best practice and intervention, has not enjoyed the level of uptake as had first been anticipated. With the objective to assess the baseline awareness of Adverse Drug Reaction (ADR) identification, reporting and the perceived barriers to reporting, Estelle McCoy from the Ulster Hospital also aimed to assess whether a potential role for Medicines Information (MI) pharmacists exists in increasing regional ADR reporting. “Yellow card reporting of ADRs has positive implications with regards to medicines governance and risk management,” Estelle said. “Increased reporting affords the early identification of previously unrecognised ADRs and assists in the detection of potential safety concerns for a drug; in addition to improving drug safety data reports allowing more informed prescribing decisions to be made. “I made two questionnaire based assessments and collated regional ADR themed enquiries as well as looking at the role of MI pharmacists. The results from the first investigation indicated that there is a considerable lack of understanding regarding the basics of ADR reporting.” To apprehend why this could be, Estelle surveyed healthcare professionals and discovered that a lack of confidence in suspicions, time constraints and not knowing what to report were all perceived barriers to reporting. A lack of knowledge surrounding black triangle drugs, those which are newly licensed or existing drugs which have new indications, was also a cause for concern. “The second investigation approximated that the potential annual contribution of MI to yellow card reporting in Northern Ireland would lead to 762.8 reports; an increase of 46.08 per cent,” observed Estelle. “This of course confirms a significant potential role for MI pharmacists in improving reporting.” The Department of Health and NICE guidelines recommend that all patients with chronic kidney disease (CKD) should be vaccinated as soon as it is anticipated that they may require dialysis. Pre-reg Alan Tinsley investigated whether Fendrix, the current vaccination prescribed at Daisy Hill Hospital’s haemodialysis (HD) unit, had shown improvements in responsiveness since the unit switched from HBvaxPRO. “Data was retrieved on all haemodialysis patients who had received HD from the Trust’s software program, known as filemaker-pro and imported onto a spreadsheet,” Alan explained. “The antibody titres for 94 patients were analysed, indicating that those titres that were less than ten were classed as non responders, between ten and 99 were classed as partial responders and those with over 100 were responders.” The results of the audit have prompted the renal unit to reassess their vaccination programme for these patients. After very careful consideration, the judging panel, which included Dr Eileen Scott, recently retired pre-registration facilitator, PSNI, Dr Colin Adair, director of NICPLD, Dr Jill Mairs, regional procurement pharmacist and Mr Howard Tebby, hospital support manager for Pfizer named Colette Lynch as the winner. |