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Published on 16 April 2009

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Who checks the pharmacist?

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In the changing role of the hospital pharmacist, pharmacist prescribing is a logical step forward. But who will perform the safety checks that pharmacists now perform for prescribing physicians?

Ray Fitzpatrick
Consultant editor

In the last edition of HPE I focused on the changing medicines landscape and the opportunities and challenges this presents to those of us in working in the hospital environment. In this edition of HPE there is yet more evidence of this changing landscape with a range of articles on new medicines. The challenge for hospital pharmacy is how to cope with the ever increasing and ever more complex medicines management agenda.

It is timely that this edition also carries an article describing the discussions that took place at the recent global conference on the future of hospital pharmacy hosted by the hospital pharmacy section of FIP. Whilst there is clearly a diverse approach to hospital pharmacy practice globally, within Europe there is a recognition that pharmacists should be taking on more clinical roles, including prescribing. In the UK, clinical pharmacy is well established and legislation now permits pharmacists to prescribe medicines (and Beverly Chambers describes how this can be implemented in the acute admissions setting on page 56).

However, who should clinically check a prescription written by a pharmacist? It would be unsafe to suggest that pharmacists’ prescriptions do not need a clinical check, but is it cost effective or practical to have a second pharmacist clinically check a pharmacist prescription?

One approach would be for prescribing to be restricted to advanced-level practitioners, with general-level practitioners
undertaking the clinical check. However, this may not be practical since in the UK pharmacists can train to become a prescriber after being registered for only two years.

Furthermore, there is already a shortage of hospital
pharmacists globally, as identified at the FIP conference, and so we may struggle to release pharmacists to take on prescribing roles.

A radical alternative would be for an appropriately trained technician to clinically screen a pharmacist’s prescription.

This may seem like a role extension too far, but let me explain the logic. The pharmacist’s clinical review is to ensure the prescription is safe, rational and economic. A suitably trained
technician working to a protocol could check for key safety issues such as dose, interactions, etc, particularly as modern pharmacy computers and electronic prescribing systems have built-in safety features, with alerts for incorrect doses, interactions and allergies. A prescription created by a pharmacist in this way would not require a check for appropriateness, or economy, since that is the whole point of pharmacist prescribing.

I am not suggesting that this type of role extension for technicians can occur in the short term, since technician training would need to be enhanced to equip them for such a role, but we need to consider this as an option if pharmacists are to fully engage in prescribing.

Pharmacist prescribing is the logical extension to clinical pharmacy, since we are the medicines experts. However,
we also need to maximise the skills of our technician workforce in managing the dispensing of medicines.

Just as the medicines landscape is changing, so too must the roles and responsibilities of the whole pharmacy workforce in order that we can best serve the needs of the patient and the hospitals we work for.



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