The Pharmaceutical Journal
Vol 280 No 7484 p18-19
5/12 January 2008

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• The profession (4)
• Controlled drugs
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• Influenza
• Prescribing (2)
• Glaucoma care
• Drug development
• Christmas

Letters to the Editor

Prescribing

Opportunity for multidisciplinary working

From Ms S. M. Brewer, MRPharmS

I write regarding the Broad spectrum article in the PJ of 1 December 2007 titled “Independent prescribing adds value” (p620). As an admissions ward pharmacist currently undertaking the conversion course to independent prescribing, I broadly welcome David Gibson’s comments.

I would, however, like to offer the following comments.

First, in my opinion, the post-take ward round is the most appropriate time for the pharmacist to employ his or her pharmaceutical knowledge and prescribing skills. The patient’s interests are best served by having the consultant and the pharmacist agree a drug treatment plan. The pharmacist then prescribes as appropriate and if he or she is competent to do so.

As all clinical pharmacists know well, the inexperience of junior doctors often means they prescribe the medication discussed incorrectly or merely act as scribes to the pharmacists’ instructions on dosage, formulation, etc.

In addition they may also be tired after a busy night shift. In the multidisciplinary team, it is the best use of skills to leave medicines management and prescribing to the pharmacist while the newly qualified junior doctor may retrieve blood results, complete requests for investigations and retrieve old notes, etc.

A busy post-take round with pressure on beds is not the appropriate forum to train junior doctors about prescribing.

The introduction of formalised F1 (year one) prescribing training and examinations has illustrated how inadequately prepared newly qualified doctors are to prescribe. Indeed some trusts have taken the initiative and withdrawn prescribing rights from those at this level until they have passed the prescribing examination.

This formalised training, on a group or one-to-one level, is the most appropriate way of gaining prescribing skills, with the minimal risk to the patient. This may be supplemented by informal feedback on a weekly consultant ward round on a general ward.

I do not consider prescribing any medicine a “menial task”. Rather that the pharmacist is increasingly recognised as the expert in medicines and taking the additional step of prescribing with our specialised fields is the logical next step.

This should free pharmacist and doctor time, in which more time can be spent with the patient doing medication reviews, etc, while the doctor has more time to hone his or her diagnostic skills. This is all to the benefit of the patient.

Lastly, Mr Gibson recognises that the standard office hours undertaken by most pharmacists are not compatible with a 24-hour acute admissions ward. However, we have taken steps to address this problem by partial introduction of a 12-hour shift (7am to 7.30pm) to our admissions unit.

There is also the flexibility of shorter early (7am to 1pm) or back (2pm to 7.30pm) shifts. When aligned with emergency duty commitments this work pattern has proven to be attractive to staff with family commitments or a desire to explore the Lake District.

It has also been popular with the ward staff and ultimately the patient who may obtain rapid supply of the correct medication or facilitation of an early discharge.

I think we can all agree that the introduction of independent pharmacist prescribing represents an opportunity for enhanced multidisciplinary working on the admissions unit and ultimately improvements in patient care.

Siobhan Brewer
Emergency Admissions unit Pharmacist
West Cumberland Hospital

Pharmacist prescribing is beneficial for everyone

From Mrs B. Chambers, MRPharmS, and Mrs N. E. Wake, MRPharmS

We echo the Broad spectrum article that supports pharmacist prescribing (PJ, 1 December 2007, p620). Pharmacists at Northumbria Healthcare NHS Foundation Trust have been prescribing on admissions units since July 2007; their role developed as they desired accountability for the therapeutic decisions they made as part of the multidisciplinary team (MDT).

Evaluation of the development showed that 50 per cent of patients had one or more items prescribed for them including a new medicine following a diagnosis by the medical consultant, regular medicines unintentionally missed on admission and optimisation of therapy (primarily analgesia).

Members of the MDT (40 people) were asked their opinions about pharmacist prescribing on the unit. All were positive about the service and 92 per cent were confident that pharmacists possess sufficient knowledge to prescribe effectively.

Of the 40, 22 per cent thought that the prescribing skills of junior doctors would be negatively affected due to there being fewer prescribing opportunities.

However, 28 per cent felt that the prescribing skills would be positively affected as the junior doctors would learn good practice from the pharmacists. All medical consultants are confident that the pharmacists work within their competence.

In response to David McNaughton who was saddened to learn that we must have our medical colleagues as mentors when undertaking prescribing training (PJ, 15 December 2007, p681), our trust’s experience has been that medical consultants who have mentored pharmacists have positively contributed to the success of the service, ensuring it is supported at all levels within the organisation.

Our experience of pharmacist prescribing on admissions units is that it has positive benefits for pharmacists, our patients and our professional colleagues. We recognise that the service is not always straightforward to implement and are delighted to be providing pharmacists with a tool for planning and implementing prescribing at the UK Clinical Pharmacy Association’s Emergency Care Group Study Day in March 2008.

Beverley Chambers
Senior Clinical Pharmacist, Emergency Care
Nicola Wake
Lead Clinical Pharmacist, Medicine
Northumbria Healthcare NHS Foundation Trust

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