For example, the two biggest roles of the clinical pharmacist in the UK is to do medication reconciliations and sign off on discharge medication lists. I think we would benefit from having similar mandated policies in place in the states. It's a bit different here since patients are actually discharged with their medication instead of just the prescriptions; therefore, it makes sense that a pharmacist would have to sign off on the discharge list, but even with just the prescription, I think a pharmacist should be more involved in the discharge process. I think that most healthcare professionals would agree with this; however, hospitals are often under staffed and pharmacists are often spread to thin as is in order to do this for every patient. I do think that discharge counseling/sign off and medication reconciliations need to be made more of a priority in the states with standards to adhere to and consequences if the standards fail to be met.
The NHS has set up a program that allows technicians to help with obtaining drug history and medication reconciliations in the hopes that it will free up the pharmacist to focus more on the clinical aspect. I like this idea too. A technician with additional training can perform a med rec and then a pharmacist is required to sign off on it. The standard in place requires medication reconciliations to be done within 24 hours of admittance.
The process of obtaining a prescription in the hospital consists of a doctor writing a written order (similar to community pharmacy - most of the prescriptions are written instead of electronic) or providing a verbal order to a pharmacist. A pharmacist will then do a clinical check of the prescription either on the ward or when it comes into the inpatient/satellite pharmacy. From that point on, a pharmacist does not see the prescription. Opposite of the states, once a technician prepares the prescription, an accuracy checking technician can perform the final check of the prescription.
The inpatient pharmacies all have robots which not only choose the stock but also put the stock away for you. I want one of those. Also similar to community pharmacy, the medications dispensed are in the original containers and are either in 28/30 day supply or in typical treatment duration quantity (i.e. 7 or 14 days for some antibiotics)
The second part of our day at Salford we followed another clinical pharmacist, Adam, on the two wards that he is in charge of. He walked us through a typical discharge process and how he performs a clinical check of the prescriptions written. We were able to witness an interaction between Adam and a couple of doctors on questions that had arisen on orders they had written.
Wednesday Elise and I went to Central Manchester University Hospitals. I was definitely in love with the place the moment I walked in. Central Manchester is made up of 4 separate hospitals interconnected together with various other speciality clinics/centers surrounding it. The four hospitals that make up Central Manchester are Manchester Royal Infirmary, Manchester Royal Eye Hospital, Saint Mary's Hospital, Royal Manchester Children's Hospital. Saint Mary's is a woman's hospital that deals primarily in obstetrics and gynecology.
The day started off with a brief tour of the different hospitals and then we shadowed several different speciality pharmacists to include bone marrow transplant, hematology/oncology, opthalmology, cardio (manchester heart center), renal transplant, and HIV. The same standards and job roles of clinical pharmacists that took place at Salford were in place at Central Manchester. It was really neat to get to see the various types of pharmacy present there and the day to day roles of the pharmacists in each area.
Thursday Elise and I swapped places at the Boots locations we were at on Monday. I went to Trafford Center Thursday which is a HUGE store in a shopping center (basically a mall). I ended up speaking with a few patients/providing them with some advice which was nice.
Tomorrow Elise and I are going to Wethenshaw which is another hospital in Manchester. We will be spending all of next week there. As for this weekend, we're headed off to London!
Here are some pictures of the hospital:
Children's Hospital
St. Mary's Womens Hospital
Eye Hospital
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