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The Pharmaceutical Journal Vol 264 No 7083 p256-259
February 12, Letters

PALLATIVE CARE

Need for a network

From Mrs J. Urie, MRPharmS, and Mr S. M. Bryson, MRPharmS

SIR,—We note with interest the announcement (PJ, November 27, 1999, 845) of the first annual Merck Sharp and Dohme joint award of the Guild of Healthcare Pharmacists and the National Pharmaceutical Association. "The award will support a project to establish a network of designated specialist palliative care community pharmacists, to deliver multidisciplinary training on drug use in palliative care, to improve the quality of prescribing in community palliative care and to promote pharmacy services. The project will involve six community pharmacists who will work with a hospital pharmacy specialist in palliative care". This echoes similar work which has recently been completed in Greater Glasgow health board.
In 1995, the GGHB appointed an area specialist pharmacist in palliative care. Early work to prioritise the needs of palliative care patients identified problems with the prescribing and dispensing of complex treatments in the community. An exercise was undertaken by the palliative care pharmacist to quantify the extent of the problem and the consequences for patients and their carers. While the incidence was low, it was clear there was a risk to proper continuity of care for patients and there was evidence of carers suffering the anxiety of successive pharmacies being unable to dispense a prescription.
In February, 1998, a pilot scheme was set up in six community pharmacies in the Glasgow area with the support of the area pharmaceutical committee. The pharmacists received appropriate training, resources and additional stocks of palliative care drugs to meet the needs of these patients. The pharmacists also committed to being available outside normal opening hours, if required.
Patients or carers present the prescription for palliative care drugs at their usual community pharmacy. In the event of needing (i) a complex dispensing
procedure, (ii) a specialist administration device, (iii) a large quantity of high dose analgesics or (iv) specialist advice, the initial prescription was referred to one of the six designated pharmacies. Responsibility for ongoing therapy typically returned to the patient's regular pharmacy.
The system was evaluated over a one-year period. Key results were:


We believe these initial findings demonstrate the success of this specialised service in community pharmacy. The aim is to establish the scheme as part of ongoing pharmaceutical service provision for patients in Glasgow. We also intend to develop the pharmaceutical care of patients receiving palliation therapy, through the local health care co-operatives in the next financial year.
The Glasgow project therefore has many similarities to the work proposed by the Hull and East Riding pharmacy development group. We hope that our observations will provide useful background for the award work. A palliative care conference, proposed for autumn, 2000, should provide a platform for sharing the experiences of pharmacists involved in these and similar schemes. We hope this letter will encourage networking of pharmacists in specialist

Jane Urie Palliative Care Pharmacist, Stobhill Hospital, North Glasgow Hospitals University NHS Trust Scott Bryson Pharmaceutical Adviser, Greater Glasgow Health Boar