Patient risk of too few hospital pharmacists

Sandra Melville

VIEWPOINT
Sandra Melville
Pharmacist, Royal Pharmaceutical Society

A quarter of the UK junior pharmacist posts in hospitals are currently vacant.

Hospital pharmacy. Pic:John Cole, SPL
Pharmacists can spot prescribing errors

These staff do clinical work on wards, check the safety and efficacy of prescriptions.

In this week's Scrubbing Up, pharmacist Sandra Melville warns that the shortages could put patients at risk.

Pharmacists are becoming increasingly recognised, by the public and government alike, as key players in looking after the health of our nation.

Their roles have evolved in recent years from a traditional focus on dispensing to include a broader remit of giving advice, not only on the safe and effective use of medicines, but more generally on health issues too.

They provide extended services such as health checks, pharmacist-run clinics and, in Scotland, the innovative 'Minor Ailments Service.'

Through this service patients can access free advice and where appropriate, prescribed medicines for a range of ailments, without having to wait for a GP appointment.

The public is now recognising the valuable resource they have right there on their high street, where accessibility is a major advantage.

But that's only part of the story. What most people don't see is the crucial contribution pharmacists make to patient care and, indeed, patient safety in our hospitals.

Picking up errors

For just as community pharmacists have moved from being based in the dispensary to delivering front-line services, so in hospitals there has been a parallel movement from the hospital dispensary to the wards, where they have become key members of the healthcare team, using their expertise to optimise therapies in specialist areas such as renal medicine, intensive care, cardiology and cancer.

The resultant prescription would have meant the patient being under-treated and increased the risk of serious liver damage

As medicines become increasingly more complex, increased involvement of pharmacists on our hospital wards has been shown to be paramount to patient care as they can optimise the safe and effective use of medicines.

This was highlighted recently in a report by the General Medical Council, which showed a 10% error rate in hospital prescribing by junior doctors. It cited how valuable pharmacists are in picking up prescribing errors and intervening before they reach patients.
Other
Junior doctors have a 10% prescribing error rate

Examples include in one hospital a patient being prescribed methotrexate for arthritis daily when it should be weekly. This was spotted by pharmacist on the ward who intervened and prevented the patient receiving what could potentially have been a serious overdose.

In another case a patient was admitted to acute medical ward following overdose of paracetamol. Acetylcysteine was prescribed to prevent liver damage but the doctor miscalculated the dose. The resultant prescription would have meant the patient being under-treated and increased the risk of serious liver damage.

The pharmacist on the ward intervened and corrected prescription and the patient is OK.

From a pharmacist's perspective, having the opportunity to use their expertise in this appropriate fashion is something we have been working towards for some time, and is tremendously satisfying, so this new trend should be a win-win situation.

Why then, is there such a shortage of hospital pharmacists? To answer this, it is worth looking at where the problem lies. Figures show that the main shortage is at basic grade level ("Band 6").

Recent figures show a 24 % vacancy rate of Band 6 pharmacists in England, and in Scotland, where that figure rises to 40%, the situation is even worse.

I recently had the pleasure of contributing to the training of two pharmacy graduates who are due to register as pharmacists this summer. Both were in the process of completing their pre-registration year - the practical aspect of pharmacists' training, following a Masters degree in Pharmacy.

They had chosen to do this in community pharmacies but are required to spend a portion of their time in hospitals. Both were enormously impressed at the opportunity hospital pharmacy would afford them to use their skills to directly enhance patient care.

Safety first

However, their financial circumstances prohibited them from seeking jobs in the hospital sector once they qualified, as the pay differential between hospital and community pharmacy is too great.

The solution would therefore seem to be simple - increase the pay for hospital pharmacists, particularly at the levels where the largest problems lie.

To allow pharmacists to use their expertise most effectively there needs to be more of them practising, and being rewarded, at a more appropriate level.

Yes - but it's also essential that we look at the bigger picture.

Pharmacists are highly trained professionals. As more complex, potent and expensive therapies continue to be developed it becomes all the more pertinent that these medicines are used safely, effectively, and cost effectively.

To do that we need to utilise fully the resource that lies within the whole pharmacy team. To allow pharmacists to use their expertise most effectively there needs to be more of them practising, and being rewarded, at a more appropriate level.

This model should ensure that the skills and expertise of pharmacists and pharmacy technicians are utilised fully and the end result would be enhanced patient care, effective use of resources and increased job satisfaction, suitably rewarded.

Once that is done a career in hospital pharmacy will regain its appeal and hopefully our pre-registration graduates will see an equitable choice ahead of them.

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