Hospital Pharmacist
Vol 10 No 5 p198
May 2003

GHP 2003: Patient focus

Two take-home messages from the conference were to be aware of developments in modern manufacturing and information technology, said JOHN FARRELL, principal pharmaceutical officer, secondary care, Department of Health. During a question and answer session he highlighted the announcement made by the chief pharmacist for England, Dr Jim Smith, that hospital manufacturing units will receive £42m over the next three years (HP, May, p189). Mr Farrell added: "Over the next few months, we will issue guidance on the service. The aims are for patients to have access to the medicines they need and to create a cohesive service."

Have professional networks been diluted by "Shifting the balance of power", the panel was asked. SHIVAUN GAMMIE, strategic pharmaceutical adviser, Torbay Primary Care Trust, said there were good local networks but she felt some fragmentation had occurred. John Farrell added: "It strikes me that the same people are involved in all the networks. We need to draw new people in." Meanwhile PHILIP HOWARD, clinical pharmacy manager, Leeds Teaching Hospitals NHS Trust, said: "The problem comes when the Department of Health wants to contact someone with particular pharmaceutical knowledge." To overcome this, he suggested that the Royal Pharmaceutical Society should set up colleges for specialist areas. Existing networks and groups could be involved in the colleges.

JOHN SITHERS, group commercial manager, Pharmacia, said that the setting up of the National Institute for Clinical Excellence had led to a new phrase: "NICE bite". He explained that when a new drug was launched, people waited for NICE approval before using it, thus causing a skewed up-take. "Is it appropriate for NICE to make decisions on cutting edge drugs when we are still feeling our way with them?" he asked.

Turning to modernisation, CHRIS CAIRNS, director of pharmacy, University Hospital Lewisham, said: "Modernisation is a long process but what frustrates me is that colleagues put up barriers to change." He stressed that at his hospital, modernisation was being achieved with a third of staff posts vacant. Mr Cairns urged colleagues to stop putting up barriers and to concentrate on big issues such as automation. Ms Gammie added: "The primary care modernisation agenda is in desperate need of electronic prescribing and electronic dispensing. There is only a limited amount of work that can be done before knowing which electronic system will be introduced. A lot of the frustration comes from here."

The Kennedy report

The most striking thing about the Kennedy report is that a change in the culture of the NHS is needed, said DEBORAH EVANS, chief executive, Bristol South and West PCT. She had worked at the Bristol Royal Infirmary at the end of the 1980s and was called as a witness in the Kennedy inquiry. "I felt that the final report was fair and that its recommendations were extremely sound," she said. "However, it presented some profound challenges to the health service."

A key theme in the report was asking the question "who are we running the NHS for: us or the people who use the system?" she said. This gave issues around empowerment, communication and consent. "Communication and team work are critical issues," she added.

Another important theme in the report was the competency of health professionals, Ms Evans said. This included recruiting the right people, then considering revalidation, appraisal and a system for dealing with poor performance. It needs to be made clear who is responsible for performance monitoring and there has to be a culture of openness to allow whistle-blowing. Ms Evans also identified that a system response that was open to new ideas was important. "It is all about a learning culture," she said.

Prescribing standards

Professor Phil Routledge, professor of clinical pharmacology and head of the department of pharmacology, therapeutics and toxicology, University of Wales, explored standards needed in prescribing. He suggested that prescribers should commit to: prescribing medicines only when appropriate and necessary, fully informing patients about what medicines do, reporting errors, reporting adverse drug events, thoroughly knowing drugs prescribed regularly and establishing partnerships to monitor therapy.

"Pharmacists have the knowledge to be good prescribers," said Professor Routledge. "But prescribing is only part of the process: communication skills are also crucial."

It is fine to give pharmacists prescribing power, but difficult to measure the quality of prescribing, he said. Using quality standards such as National Service Frameworks or measuring prescribing against other health care professionals was possible. Since 1996, the Welsh Medicines Resource Centre had sent out case study-based distance learning modules to both primary care pharmacists and general practitioners.

Analysis of a module about heart failure, completed by 570 GPs and 47 pharmacists, showed differences between the professions. "Of the GPs, 37 per cent selected an appropriate dose of ACE inhibitor compared with 67 per cent of pharmacists. Meanwhile, 63 per cent of GPs and 78 per cent of pharmacists chose appropriate, licensed doses of beta-blockers," reported Professor Routledge.

Using technology and automation could progress prescribing standards. "We need to look at introducing decision support systems in hospital along the lines of those used in primary care. It could reduce the risk of ADRs because we can't remember everything," he said.

Baxter Award lecture

The Baxter Award lecture was given by Uttam Chouhan, principal pharmacist, clinical services, Glan Clwyd Hospital. In 1998, a new acute pain relief service using epidural infusions of fentanyl and bupivacaine was introduced at the hospital. Mr Chouhan explained that this had been in response to problems with the earlier system, including pain relief running out and patients being able to change infusion rates. "We wanted to simplify the process and make it a safer system," he said.

The solution was the introduction of 500ml infusion bags that last for up to five days, provide continuous pain relief, and save both pharmacist and nurse time. "Nearly 1,200 patients have received this mode of delivery for pain relief and it is well accepted," he said. There have been no adverse clinical incidents. A recent hiccup was the closure of the infusion bag manufacturer, but the hospital has managed to find an alternative source — albeit that the solution is at a slightly lower strength.

The winners of the 2003 GHP Baxter Healthcare Medication Delivery Award are Alison Beaney, regional quality assurance specialist, Anne Black, quality assurance pharmacist, and Clare Dobson, pharmacy student, from Freeman hospital, Newcastle upon Tyne. The award was made for their work on developing a risk assessment tool to improve the safety of intravenous preparations.