Clinical Services

The Clinical Team consists of Pharmacists, two Directorate Technicians and three Medicines Management Technicians.

The Pharmacist clinical visit is supported on MAU, and some of the medical and surgical wards by the Technicians. The Technician’s role is to manage the ordering of non-stock items and to assess patients’ own medicines. A competency programme has (and continues) to be developed, to ensure the Technicians are confident and fully trained in working on the wards. The two Directorate Technicians have a supporting role to implement new initiatives in Medicines Management and is very much under continual development. They have undertaken an audit to secure funding for the use of patients’ own medicines on discharge and are the facilitators for the Technician training to extend their colleagues’ roles. Their clinical skills are being enhanced with the BTEC Professional Development Certificate for Clinical Pharmacy Technicians, and this will give us ideas of where they may progress further in this new field.

Our Medical Admissions Unit Pharmacist ensures that the majority of patients admitted to the Unit will be seen during normal working hours. As all Ward Pharmacists, they are also involved in prescription review, drug history taking, providing advice and counselling to patients and carers, and in the production of Medicines Management Care Plans. This Pharmacist plays a key role on the Medical Post-take Team, providing prescribing advice to all grades of medical staff at the point of prescribing.

Medicines Management Care Plans are used by Pharmacists working on medical wards, in what is a fully integrated Medical Directorate.

The Medicines Management Care Plans form the basis of a working document, which is used to provide information on medication to patients’ GPs upon discharge. A computer-generated summary is faxed to GPs detailing all aspects of drug therapy and reasons for any changes as a supplement to the medical staff’s discharge letter.

We are striving to meet targets set in National Service Frameworks, particularly in Coronary Heart Disease where a Specialist Pharmaceutical Service including participation in cardiac rehabilitation is provided, in older people with medication review on admission to hospital, and on a dedicated Stroke Unit with comprehensive pharmaceutical input.

We are working towards a procedure to allow Pharmacists to make adjustments to solve certain prescribing issues without reference to prescribers, enabling safe and effective medicines administration and reducing pressure on Junior Doctors hours.

In addition to clinical visits to the three Surgical wards, one Urology ward and one Gynaecological ward, there are opportunities to work with the multi-disciplinary Acute Pain Team (Consultant Anaesthetist, Pain Nurse Specialist and other members of the Recovery Team) on a weekly ward round. Development of Acute Pain guidelines for use within the different specialities is being led by the Acute Pain Team and Surgical Pharmacist.

Pharmacists rotating through the Surgical Directorate have a comprehensive programme to cover all the important issues, eg PONV, pain relief, antibiotic prophylaxis and thromboprophylaxis. They attend the Pre-admission Clinic, pain round and ward visits with other professionals such as the Nutrition Team, Physiotherapists and Stoma Care Nurses to understand and widen their knowledge of the whole surgical care package.

The Pre-admission Clinics at NGH are becoming more structured, and although awaiting funding for the expansion, Pharmacists have been involved since the early stages. This was following a successful pilot of the involvement of Pharmacists in the Pre-admission Clinic, where the role was to take a complete drug history, write in patient charts and TTOs, and advise patients as to what medication they need to continue or stop throughout their stay. One of the most important outcomes of the project was that the discharge process was smoother as TTOs were prepared in advance and patients did not need to wait.

With the appointment of a Trauma Pharmacist, the service to the Orthopaedic Directorate has become more co-ordinated, with support for Accident and Emergency also. As the new Orthopaedic Day Surgery Unit opened, the Pharmacist ensured a smooth supply of TTO prepacks to enable speedy discharge of patients.

On a daily basis, a Pharmacist actively participates in the ITU ward round. Twice a week, a Pharmacist attends a ward round with the Consultant Microbiologist on ITU. Consequently, links with Physicians, Surgeons, Anaesthetists, Nursing staff and Dietitians is very good on the Unit.

Pharmacists provide pharmaceutical advice to all Directorates, mainly by producing quarterly Prescribing Reports, containing prescribing and expenditure information. This information is most commonly shared with senior medical staff, Directorate Managers and Directorate Accountants, in some instances by the Pharmacist attending the Directorate meeting. The trends identified can lead to opportunities for audit, which Directorate Pharmacists are encouraged to lead.

Each Directorate Pharmacist performs a liaision role with their Directorate and is available to provide advice and support on Formulary submissions, business cases for new treatments/extended indications, in prescribing guidelines and Patient Group Directions. This is an important role to lead the Trust’s developments on Medicines Management issues.

Pharmacists maintain membership on a number of multidisciplinary committees, eg, Drug and Therapeutics Committee, Formulary Committee, Nutrition Team, Tissue Viability Group, Research and Development Steering Group, Research Ethics Committee and Pre-admission Clinic Steering Group.

The Clinical Team also shares experience and knowledge at weekly meetings, which form the basis of a CPD programme. This includes teaching sessions from peers and outside speakers, a journal club on a rolloing programme and regular critical appraisal sessions. The department holds accreditation with the College of Pharmacy Practice, which we are currently seeking to extend.

We have an extensive self-developed audit programme under development, to shape our practice towards a patient-focused approach, as suggested in the NHS Plan.

Pharmacists at Northampton General Hospital can spread their wings into other professions as well – teaching both within the Pharmacy Department, within the Trust and to Primary Care.

We provide comprehensive training of vacation Pharmacy Students, Pre-registration and Diploma Pharmacists, with Senior Pharmacists working as accredited tutors for the Diploma, and have had very positive feedback on this very structured approach.

Pharmacists are involved with the induction of the new Junior House Officers as they start their life as Doctors – a very important job, as this is when they are most impressionable! Pharmacists take an active role in the training of Nurses, including: drug calculations, IV study days, and pain and drugs used in Urology. A more extensive training plan is to be developed for the Nursing staff over the next few years.