Pharmacists must be part of the multidisciplinary teams reviewing group protocols for the administration of medicines, the review team headed by Dr June Crown has recommended.
In its report on the supply and administration of medicines under group protocols, published on April 21, the review team says that the majority of patients should continue to receive medicines on an individual basis. However, patients may receive pre-packaged medicines under group protocols where this is likely to be of benefit by reducing waiting times, speeding discharge or preventing hospitalisation or to make appropriate use of professional skills.
The review recommends that all current protocols should be reviewed to ensure that they comply with the criteria it proposes. The review should be undertaken by a team which includes a doctor and a pharmacist and the protocols should be checked by relevant clinical managers, including trust chief pharmacists. The protocol should include a clear definition of the situation to which it will apply, patient inclusion and exclusion criteria and action to be taken for patients who are excluded.
The details of professional qualifications and training necessary for staff undertaking supply or administration under a protocol will need to be detailed.
The medicines to be supplied must be listed in detail, together with advice to be given to patients and arrangements for medical referral and treatment of adverse effects.
Protocols will need to list the names of the professionals, managers and advisory groups which have been involved in drawing them up and have a review date after which they are no longer valid.
When the reviewed protocols are implemented, the Crown review team recommends that "health professionals supplying or administering medicines under group protocols must be named and have evidence of competence, training, knowledge, experience and continuing education relevant to the clinical condition to which the protocol applies". The naming of staff within the protocol might lead to problems in departments which employed a large number of temporary or locum staff.
Welcoming the report, the Secretary of State for Health (Mr Frank Dobson) said that the Department of Health would be addressing the outstanding legal ambiguities surrounding group protocols to ensure that health professionals were not compromised in law.
The Royal Pharmaceutical Society expressed support for the report's main conclusions and welcomed the opportunity to be directly involved in establishing criteria for group protocols.
Mr Roger Odd (head of the Society's practice division) agreed with the findings that regulations needed clarifying to ensure that only appropriately trained professionals would be able to supply or administer medicines under approved group protocols. "Pharmacists have an important role to play in drawing up effective local group protocols and also in advising on their implementation through professional advisory committees," he said. "Patient safety and effective use of medication will be paramount and involve reference back to pharmacists and doctors where needed."
Mr Odd said that the Society would want to ensure that protocols were clearly written, provide a mechanism for an audit trail and be subject to evaluation of health outcomes.
The Guild of Healthcare Pharmacists welcomed the key role given to pharmacists in drawing up and monitoring the protocols. Mr Peter Cooke (president, GHP) said: "Our members, particularly trust chief pharmacists and those involved with the registration of private nursing homes, now have a clear responsibility to ensure that the review team's recommendations are implemented."
The report has been distributed within the National Health Service under cover of Health Service Circular HSC 1998/051. The main report of the Crown review team is expected to be published in the summer.