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Rethinking pharmacy services



Christine Clark BSc, MSc, PhD,
FRPharmS, FCPP(Hon)

Editor HPE



Two recent pharmacy meetings have underlined powerfully the ways in 

which pharmacy services have grown and continue to grow and develop to meet the community’s needs better. At both the ESCP congress (see page 10) and B Braun Medical seminar (see page 14) audiences heard thought-provoking presentations. Both meetings were packed with gems and some of the points have such important implications for pharmacy services that they deserve reiteration here.







The ESCP congress started with a forceful lecture from an economist who told the audience in no uncertain terms that it is possible to do more with less. Moreover, this often involves a ‘rethink’ of the way we do things, embracing new technologies and different ways of working. Tellingly, he said: “Professionals tend to think there is one way of doing things. Economists think there are many ways of doing things and want to know which is best.” 


Probably one of the best examples of a different way of working has been the integrated medicines management (IMM) project in Northern Ireland. This started as a randomised trial to compare the impact of IMM with usual care. In essence, the scheme linked up medicines reconciliation, intensive monitoring of patients’ drug treatment and a discharge protocol that combined education of patients and carers with prompt communication of medicines’ changes and the discharge prescription to both the family doctor and the patient’s community pharmacist. This genuinely managed medicines throughout the patients’ hospital journeys so that changes were documented and misunderstandings at all levels were avoided. 


This was not just a feel-good exercise for the benefits were very real – the medication appropriateness index (MAI), fell from 17.5 to 5.7 in the intervention group, average length of stay in hospital decreased by two days, and the rate of readmission was reduced such that for every 12 patients receiving the service, one readmission was prevented. There can be few better demonstrations of the value of rethinking and doing things differently. It will come as no surprise to hear that this scheme is now being rolled out to other hospitals in Northern Ireland.        




The ESCP congress contained much more to stimulate the grey matter. Amongst other things we heard that telehealth technology should be part of 21st century medicines management services and pharmacists are now taking the first steps here. We also learned that some of the areas of greatest need for pharmaceutical care are in the management of depression, in care homes and in the care of those with intellectual disability; pharmacists have also made considerable inroads in these areas. 


The B Braun Medical seminar in the UK has now become an annual event and every year it draws attention to aspects of the use of injectable medicines that tax our ingenuity. This year Irene Krämer (Director of Pharmacy, University Hospital, Mainz, Germany) presented an analysis of an event that every pharmacist dreads – contamination of an aseptically prepared product that led to the deaths of three patients. The painstaking investigation that followed eventually traced the source of contamination and the pharmacy service, which has very rigorous procedures, was completely exonerated. Professor Krämer’s candour and professionalism in presenting this harrowing story to an audience of colleagues deserves recognition of the highest order. 


Conferences and meetings should make you think about what you do, how you do it and whether you could do it better. That is their real value –  and there was no shortage of material in these two meetings to do just that.



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