The Primary and Community Care Pharmacy network, formerly the Community Services Pharmacists group, met at Harlow in Essex on October 11 and 12, for its first annual conference under its new name
Some of the presentations made described research undertaken by members. These included a Berkshire and Oxfordshire pharmacy continuing professional development (CPD) project, which was outlined by Miss CLAIRE GROUT (CPD project pharmacist, John Radcliffe trust, Oxford).
She began by explaining that lifelong CPD was linked to the needs of both the job and the individual and it encouraged "reflective" practice. The project had been established to support recruitment and retention of hospital pharmacists and to help departments to come into line with NHS requirements, such as clinical governance. The process of assessment was independent of, but approved by, the pharmacist's manager and could be used during annual appraisal. Pharmacists put together a series of criteria against which they monitored their performance. Then, with the help of a mentor, they compiled a personal development plan based on these criteria. Over a period of time, the pharmacist built up a personal portfolio that recorded achievements made, areas for improvement and training undertaken in order to meet the criteria that they had set themselves. Miss Grout said that, so far, the feedback from participants had been positive, mainly because they felt that it provided structure and priority to their learning, which made goals seem more attainable.
She concluded by saying that CPD was a cycle of planning, action, evaluation and reflection. The key to the success of CPD was that it was a continuous process, that was adaptable to changing environments and roles and that it reflected day-to-day small issues, not just "the big picture".
Mr STUART SEMPLE (clinical pharmacy co-ordinator, Guy's and St Thomas's hospital) presented a project that had resulted from pharmaceutical problems that had arisen during admission or discharge of patients from hospital.
The main issues that had been identified during admission included inaccurate drug-history taking, wastage of medicines brought into hospital and the use of unusual or non-formulary drug therapies. At discharge, problems arose in the continuity of supply once patients left hospital and through the poor exchange of information between primary and secondary care.
The focus of the project had been on the review of drug administration on wards, drug supply to both wards and patients, and dealing with patient's own medicines on admission. Suitable patients were identified who might be made responsible for custody of their own medicines and for administering them themselves. To assist this, the drug trolley system had been replaced by individual medicine cabinets at the bedside of each patient. When it was time for a medicine to be administered, either the nurse would give the patient their medicine from the cabinet or the patient would take it themselves. On discharge from hospital, prescriptions remained on the ward, instead of being sent to the pharmacy and drugs to be taken home were checked at the bedside where the medicines regime was also explained to the patient by a pharmacist.
The benefits of individual medicine cabinets were that supply was a one-step process, there was less of a wait for discharge medication and the pharmacists saw every patient immediately before discharge. Also, drug administration was more flexible.
Using patients own medication, accurate drug histories were possible on admission, duplication of supply was avoided and the disposal of drugs that had been discontinued or whose dosage had been changed was ensured. In addition, non-formulary drugs could be continued using the patient's own supply and there was less waste. By observing patients taking their own medication, it was possible to identify those who had difficulty reading labels or managing their medicines. The new model of service delivery meant that pharmaceutical problems and care needs were identified and documented.
Future work might include improving communication with general practitioners and pre-admission clinics.
Mrs LORNA CADY (community services/HIV pharmacist, St Anne's hospital, London) reported on a project that took place in schools in the London borough of Haringey. It aimed to train school staff to recognise and treat anaphylactic shock in allergic children, as most schools were found to have at least one child that had been diagnosed as having a severe allergy - often to peanuts. Teachers, welfare assistants, "dinner ladies" and clerical staff were given training by the community services pharmacist and school nurses. Parents and the local chief medical officer were also invited to attend.
Training consisted of a video that explained anaphylactic shock, discussed allergen testing and showed a simulated anaphylactic reaction, together with its treatment, in a school playground. This was followed by discussion with parents and trainees about the common causes of anaphylaxis, the action of adrenaline and the importance of calling an ambulance. Parents were encouraged to give details of their child's allergy, the allergens involved and their degree of sensitivity. Reducing the risk of food-induced anaphylaxis was covered and it was suggested that reminders that an allergic child attended the school were displayed.
The pharmacist demonstrated the correct use of devices prescribed for the child that were to be kept in a kit at the school. Finally, participants were instructed in a drill for dealing with anaphylaxis.
Mr JOE ASGHAR (pharmaceutical adviser, Northumberland health authority) described how he undertook a pilot study to assess the performance of pharmacist nursing home inspectors to see whether significant differences in practice existed between them.
Questionnaires were prepared for nursing home staff. They covered such factors as verbal and non-verbal communication, behaviour during visits and the attitudes of both inspectors and the home to the inspection. The project was piloted in North Yorkshire and 364 questionnaires were distributed, of which 284 (78 per cent) were returned. Comments made about the pharmacy inspectors indicated that they were friendly, approachable and helpful and that they were happy to answer questions.
Mr Asghar felt that the study had shown some differences in the style of the inspectors examined and in the content of their visits. He thought that a peer review process would help to improve the standard of nursing home inspectors but admitted that the balance between providing both an inspection and advisory role was difficult. He commented that some nursing home staff felt confused between the roles of inspectors and community pharmacists.
The materials used during the project needed to be modified following the pilot and a reaudit would be undertaken in another area before setting up a monitoring programme. Mr Asghar emphasised the need for positive and constructive feedback to the pharmacy inspectors and felt that relevant training might include sessions on assertiveness, organisation and problem solving.