The Pharmaceutical Journal
Vol 271 No 7260 p156-157
2 August 2003

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Putting pharmaceutics into practice

Last year, the Royal Pharmaceutical Society embarked on a novel venture: moving its pharmaceutics information service into a hospital setting. Lin-Nam Wang (on the staff of The Journal) looks at how it has worked out

Ever wondered about the stability of lanolin? Or the implications of using the wrong diluent to reconstitute an antibiotic powder? What about the licensing authority position regarding the use of genetically modified excipients in medicines for human use? Maybe one day you will need to know how to formulate a placebo powder for a clinical trial or how podophyllin compound paint must be packaged. If so, Dr Colin Cable, the Royal Pharmaceutical Society's Fellow in Pharmaceutics is the man to ask. For the past 13 years, as part of the Society's former pharmaceutics division, Dr Cable has helped members in all branches of the profession with their queries about practical pharmaceutics. Queries that he has dealt with have ranged from the obscure (eg, providing an equation to enable the mean kinetic temperature in a warehouse to be calculated) to the more usual, such as providing a formula for an oral liquid preparation that is not commercially available. Panel 1 gives examples of a few other frequently asked questions and their answers.

From 1964, the pharmaceutics information service was based within the premises of the Society's Scottish Department in Edinburgh. At that time, it consisted of a laboratory, which tested new formulations for the British Pharmaceutical Codex (BPC) and carried out experiments in order to answer problems posed by members. Following the publication of the last official edition of the BPC in 1973, there was no longer a need to develop or improve BPC formulations and the laboratory was used to develop British Standard tests for medicine measures and dispensing containers. By the mid 1980s, laboratory work had ceased and was replaced with an information and advisory service supported by a specialist pharmaceutics card based database, generated through scanning pharmaceutics journals. This initial "in-house" database was later superseded by a computer based database (the abstracts now form part of the Society's e-PIC database published by Ovid Technologies).

However, last year the service underwent another significant change: it moved from its offices within the Society's Scottish Department and set up base at the Western General Hospital in Edinburgh. This move stemmed from the reorganisation of the Society's directorates, started in 1998. As part of this reorganisation, which coincided with devolutionary changes within the Scottish Department, the various groups making up the then department of pharmaceutical sciences were separated and attached to other parts of the Society. In addition, the medicines testing laboratory, also based within the Scottish Department, was sold. This restructuring resulted in less informal contact between pharmacists and other scientists at the site, leaving Dr Cable and the pharmaceutics information service isolated.

Professor Tony Moffat, chief scientist at the Society and former head of the department of pharmaceutical sciences, found himself with the task of securing the best possible environment for the service to continue in. "We wanted to make sure that the service was not stuck out on a limb," Professor Moffat told me.

The aim was to move the service into an environment where Dr Cable could continue to have regular networking opportunities with pharmacists and other scientists. There were two options: moving the service into a hospital or into a university. "We approached the Western General first, and Norman Lannigan [trust chief pharmacist of Lothian University Hospitals NHS Trust] came through so positively that we then made hospital our choice," Professor Moffat explained.

Outcomes

As an outcome of negotiations between the Society and Western General, Dr Cable's office moved into the hospital's pharmacy department in May 2002. In exchange for the space, Dr Cable spends 30 per cent of his time working for the hospital. His duties include working on the ear, nose and throat ward. This innovative arrangement has yielded benefits to all parties concerned. The pharmaceutics information service is now attached to the Society's information centre (part of the Public Affairs and Communications Directorate) and Dr Cable enjoys closer links with colleagues at Lambeth, especially with those working in the technical information service, where telephone calls about pharmaceutics are now directed.

Going back to hospital work after a 15-year absence has presented a new challenge for Dr Cable, but he has found that it has helped him to help others by bringing him up to date: "As the pharmaceutics information service became less hands-on and practical, it became increasingly difficult to maintain a clear idea about the issues that were developing within pharmacy practice and how to respond knowledgeably. Huge changes in the types of medicines available and the approaches to patient treatment and care had taken place since I left hospital practice." In addition, the role change has presented Dr Cable with more extensive continuing professional development opportunities and he hopes that, following a period of retraining within the various areas of the hospital pharmacy (eg, in aseptic unit procedures), he can become a more integrated and useful member of the pharmacy department.

Dr Cable has also found that as his presence has become known, hospital pharmacists are beginning to direct queries to him. Moreover, the medicines information centre for the trust now contacts him if it receives any queries with a pharmaceutics component that it does not have the expertise to answer.

Dr Lannigan told me that Dr Cable's skills are a valuable resource — a type of expertise that the trust previously did not have. "There are many occasions where a knowledge and understanding of pharmaceutics principles is required in order to make a professional judgement on the best course of action for a patient [in hospital]. For example, if a patient has difficulty swallowing and no liquid based formulation is available, what are the options for formulating a suitable medicine? Such judgement is also required to assign shelf lives to extemporaneous products where no stability information is available," Dr Lannigan pointed out when I asked him how the hospital had benefited from the relationship.

The information service itself (and therefore the Society) has also made gains, because not only has it managed to continue running economically, with an improved management structure, but it is enhanced by being more closely linked with practice. For example, Dr Cable is able to look at medicines in the pharmacy and their use on wards first hand. The service has also developed a better understanding of the broader issues pharmacists face: for example, the effect that the bore of a nasogastric tube can have on the suitability of extemporaneously prepared oral liquids or the type of stability information required by a hospital pharm-acy before a new aseptically or extemporaneously prepared product can be prepared.

Although now based within a hospital pharmacy, Dr Cable continues to provide advice and information to community and primary care pharmacists on issues such as compatibility and stability when mixing oral liquids or topical medicines in an attempt to improve patient concordance or the shelf life of preparations when removed from the original packaging or when bulk containers of liquids are opened.

Furthermore, the arrangement has also helped to nurture a collaborative relationship with academic pharmacists at the University of Strathclyde. "During my initial hospital pharmacy induction, it became clear that there were many activities undertaken in practice for which there was no published chemical stability data [eg, the addition of drugs to topical gels]. As part of my hospital role, links were developed with the university to address these problems in a mutually beneficial manner," Dr Cable told me.

Although this type of collaboration had previously been pursued by the hospital, resource limitations led to only a single study being carried out. It is envisaged that Dr Cable will act as the link in the chain between the hospital and the university on an ongoing basis. The first joint study under way is an investigation into the chemical stability of a palliative care injection admixture used within Lothian. This could lead to further joint work to fill in the gaps and the pharmacy profession will benefit from this new knowledge.

So, it looks as if, in this case, everyone is a winner. Stronger bonds have been forged between the Society, hospital and academia. Society members also benefit by continuing to have access to Dr Cable's specific expertise in applying pharmaceutics knowledge to practical pharmacy issues. On a more personal level, Dr Cable has found practising hospital pharmacy a reinvigorating experience: "The joint venture has rekindled my enthusiasm for pharmacy and pharmacy practice, and served to remind me of the reasons why I wanted to become a pharmacist in the first place."

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