The launch of the National Pandemic Flu Service in England has thrown up interesting issues about the way we manage diagnosis, prescribing and the supply of medicines
BSc MSc PhD FRPharmS
As I write, the National Pandemic Flu Service (NPFS) in England is authorising the issue of a prescription-only medicine, oseltamivir (Tamiflu), to people who are diagnosed with probable swine flu using a diagnostic algorithm. Over the past week GP consultations for suspected swine have risen sharply, and the media have been full of news about conflicting advice given to patients.
The launch of the NPFS marks another step up in our response to the pandemic. We had already moved on from the original ‘containment’ strategy to treatment. We have also moved from laboratory-confirmed diagnosis to clinical diagnosis. Some have questioned whether a diagnostic algorithm can really be as good as talking to a doctor. We should perhaps remember that there are numerous examples in the medical IT literature that show that computer-assisted decision support systems function very well-often better than healthcare professionals.
The NPFS website not only makes a diagnosis but then provides an authorisation number so that medication can be collected for the patients from a designated local collection point-which is sometimes, but not always, a pharmacy. Collection points are linked to a computer system to enable them to confirm that the authorisation numbers are genuine.
This in itself is an interesting development. If it works well then it would certainly be convenient from the patient’s point of view-and the question arises whether it could work in other situations. There must be many other situations where a similar approach could be used to relieve hard-pressed healthcare professionals of some of the burden of routine work, allowing them to concentrate on cases that need their special expertise.
The other lessons to be learned from the flu pandemic will surely be in the application of infection control measures. As always in infection control, one of the most important measures is good hand hygiene. Serious campaigners will tell you that this has not always been easy to enforce amongst healthcare professionals-so how much more difficult will it be amongst the general public? The flu campaign has also urged people to use tissues when they sneeze and to cover their mouths when they cough. This seems to have had a very limited impact so far. We should all encourage these simple steps to good hygiene (and good manners).
In this issue we have a number of articles that look at key issues bearing on hospital pharmacy rather than at medicines and medical products themselves. Howard Mason (page 63) argues the case for delivering externally uncontaminated and better breakage-protected cytotoxic injections in an article about cytotoxic packaging. He also explains how the impact of labels with safety instructions can be greatly increased by appropriate training.
James Thom (page 57) describes the challenges facing radiopharmacists. A constant threat is interruption of supplies of molybdenum from five rather elderly reactors in the world.
IT applications in hospital are also in the news in this issue: Burhan Zavery (page 53) describes how a detailed capacity- planning process has enabled his department to manage the preparation of chemotherapy doses in advance and to control the pharmacy workflow in an efficient way.