Health care professionals generally welcome the initiative of change and modernisation
in the National Health Service. This modernisation agenda addresses areas such
as professional responsibility,1 pay and reward for services,2 and culminates
in a plan for health care for the next 10 years.3 The initiatives propose a
standard quality of care, accountability by the professions involved and responsibility
of individual professionals. Standards of practice must be based on best available
evidence and, when pay is driven by performance, excellence in practice is rewarded.
The Government is keen to drive out professional protectionism so that, although
standards of care and practice are generally high, specific individuals or institutions
that falter are recognised. These initiatives also require poor performance
to be reported.
Recent cases have emphasised the importance of this move and the Department
of Health has described measures to try to overcome errors in practice.4 Where
standards are not reached, chief executives will be accountable and steps will
be put in place to ensure they are met. There will be mandatory reregulation,
competency testing and continued professional development through recognised
sources in order to meet these aims. Although these times may feel threatening
to all involved in delivering health care, we propose that we have been provided
with an opportunity to develop our profession further.
Pharmacists have been described as the health care professionals who can ensure
safe and appropriate medicines management.5 With these praiseworthy skills,
we are in an ideal position to enter the era of governance and evidence-based
practice. Fundamentally, we fulfil the definition of a health professional,
in accordance with the requirements of “Agenda for change”,2 which
are: “Professions with a minimum entry requirement of three years’
educational study (or equivalent) to diploma level or higher, in a specific
area (other than medicine or dentistry) and which are state registered and have
a substantial majority of members employed in health care”.
Again, in accordance with the governance culture, we use theory-based protocols
to give advice, we take responsibility for our interventions and we fully integrate
ourselves in health care delivery. In many hospitals, the role of the pharmacist
is highly acclaimed. Pharmacists can and do recommend appropriate and safe therapy
for patients by complete involvement in the multidisciplinary
team. One example of practice, ensuring professional accountability and responsibility,
is documentation of all pharmaceutical interventions in patient notes. Although
this is common practice in some hospitals, it is not yet universal. In this
emerging culture of ensuring high quality services and professional accountability,
pharmacy may be asked to justify why documentation of all advice and professional
intervention is not routinely practised in all hospitals and community.
Medical notes are an accepted method of communication between health care professionals.
These notes document interventions and observations pertaining to a patient.
Doctors and various other therapists all use them as a method of communication.
Nurses often use their own notes, and these are later filed with the rest of
the patient’s notes and everyone knows where they are. The contribution
nursing makes to patient care is not in dispute and accountability is granted.
Pharmacists routinely mark medication charts, in green ink, to document a change
of drug, form, strength or dosage. But how easy is it for another health care
professional to identify and interpret the pharmacist’s interventions?
Would it not be clearer if all advice was written in the notes?
Perhaps the use of the term “medical notes” rather than “patient
notes” encourages the view that the notes belong to the medical team. It
is easy to assume that others prevent us from writing in the medical notes,
but this will not be a valid excuse in these days of professional reform. Whatever
the reason, we must acknowledge that responsibility and accountability are measured
by appropriate documentation. The issue of safety is central to this argument.
Medical notes were implemented to enhance patient safety by communicating patient
progress among all health care professionals. Legally, accountability is not
assured through Post-it notes or verbal communication. It is vital that we document
and report our interventions, pharmaceutical advice and recommendations for
our valid contributions to be recognised by the multidisciplinary team. Pharmacists
must document their actions every time they visit a patient and intervene on
their behalf and other members of the health care team must be able to access
the documentation to be fully informed of interventions and to be aware of the
contribution pharmacists make to overall patient care.
Being accountable for professional input is part of current Government policy.
Without developing along these lines we stand the chance of missing out in policy
and missing out in multidisciplinary working. Documentation is essential to
ensure professional accountability and to ensure the quality of professional
services in both secondary and primary care.
By offering the best advice on safe, efficacious, economically sound interventions,
including drugs, and following through with documentation in patients’
notes, we will assume a lead role in medicines management and take our rightful
place in the multidisciplinary team. We make a valuable input into patient care
and should take credit for that. Let us stand up, be accountable and ensure
that we have a valid form of documentation that summarises our routine contribution
to patient care. A unified decision to write in the patient notes is only the
beginning of further establishing the importance of pharmaceutical care in practice.
References
The authors are from the centre for practice and policy, School of Pharmacy, University of London.