Hospital Pharmacist
Vol 10 No 7 p277
July/August 2003

Review of circulars and official publications
by Alex Bower, MRPharmS

The Department of Health issued the “Hospital pharmacy initiative for promoting prudent use of antibiotics in hospitals” letter (PL/CMO/2003/3, PL/PhO/2003/3) in June.

This brief document has a major significance which goes beyond its welcome message of additional funds to develop clinical pharmacy services. This is one of the few occasions (perhaps the first?) where funds have been allocated specifically for pharmacy and signifies a sea-change in recognising the contribution that the profession can make to improvements to patient care. Almost £12m is available over the next three years specifically targeted to acute hospital pharmacy. Hospital chief pharmacists are asked to plan developments to improve the prudent use and monitoring of antibiotics in their hospital and will be expected to provide a report to the DoH on this work. This will be forwarded to strategic health authorities for performance management purposes.

The letter notes that clinical pharmacy activities have developed widely in the United Kingdom and that evidence is available to show that these activities lead to improved patient care and better use of medicines, including cost-effectiveness. Examples are quoted of good clinical pharmacy practice, including monitoring prescribing in relation to policies, ensuring parenteral antibiotics are appropriately switched to oral use, development of local evidence based guidelines in close liaison with consultant microbiologists and regular analysis with feedback to prescribers on antibiotic use.

The funding is designed to facilitate the development of clinical pharmacy services regarding antibiotic management. It is anticipated that there will be a focus on aspects such as antibiotic use in surgical prophylaxis, antibiotic use in children and infection control. The letter requires that action be taken to ensure hospital antibiotic policies are in line with current best practice and that they are evidence based. This should take place through existing groups such as hospitals’ drugs and therapeutic committees. Ways in which such hospital data on antibiotic prescribing can be captured and aggregated nationally are being explored.

Further guidance will be placed on the DoH’s website in the next few months. Hospital pharmacists should feel justifiably delighted that their role has been recognised in this way. The future challenge is to demonstrate that the funding has been used to make a real impact on antibiotic prescribing and patient care. Good luck to all those who will be involved in this major exercise!

Hospital pharmacists involved with procurement will be interested to note that the NHS Purchasing and Supply Agency has issued “performance indicators” which are available through the agency. These are made available as a self-measurement tool to help trusts measure their performance in purchasing and supply. Key performance indicators cover seven different subject areas and trusts will ultimately be able to see how they are doing in comparison to others. Those that provide data will receive a tailored report, with explanatory notes, showing their performance against a similar group of trusts.

The indicators include an assessment of savings achieved as a percentage of non-pay expenditure and some that are directed at assessing progress with electronic data interchange. Hospital pharmacy procurement pharmacists might wish to use the document as a stimulus to review practices for the procurement of drugs and ensure that these practices are as well developed as possible.

The Public Accounts Committee has recently published its “Public Accounts – Twenty-Sixth Report”, which is available here.

This reviews the work of the former Medicines Control Agency (MCA), which was (along with the former Medical Devices Agency) superceded by the Medicines and Healthcare Products Regulatory Agency (MHRA) in April 2003. The report concludes that there was a lack of dynamism in the efforts of the MCA to develop further improvements in the protection of public health. It cites the limited success to improve the reporting of adverse reactions by health professionals and notes that the agency has not increased reporting levels above the current estimate of 10–25 per cent.

The perceived failure of the MCA to control the quality of many leaflets and labels designed to alert doctors and patients to potential risks was also highlighted. The report asks the MHRA to measure the effectiveness of the safety and alert warnings it issues in changing prescribing habits.

Similarly, a perceived failure to regulate the widespread but unmonitored practice of prescribing drugs to children that, while licensed, are not specifically approved for paediatric use is also highlighted. The report suggests that the MHRA tackle this by obtaining better information on the extent of adverse reactions arising form such situations on the basis that this information could be used to influence the pharmaceutical industry to increase the number of medicines specifically approved for use with children. Hospital pharmacists will no doubt want to become involved with this work by providing such information.

The annual report of the Chief Medical Officer (CMO) for England was published recently. It is available here.

The safe adminstration of intrathecal chemotherapy is among the issues highlighted in the report. The Department of Health is working with manufacturers of intrathecal chemotherapy to identify a design solution to the problem. In the meantime, the CMO says that some local NHS organisations have been slow in complying with the national guidance on eliminating errors associated with intrathecal chemotherapy that has been produced.

Concerns over the dangers of passive smoking, the risk of West Nile fever entering the UK and rising levels of obesity are also covered.

  * PDF files on PJ Online require Acrobat Reader 4 or later.

Mr Bower is a consultant pharmacist