The role of pharmacy technicians is already well established in departmental activities such as dispensing and aseptic services.
The role of pharmacy technicians in clinical pharmacy services
The role of pharmacy
technicians is already well established in departmental activities such as
dispensing and aseptic services. However, the expansion of clinical pharmacy
services in hospital would not be possible without the additional support that
can be provided by hospital pharmacy technicians. In a similar manner to the
way in which ward pharmacy services provided by pharmacists evolved into
clinical pharmacy, pharmacy technicians’ roles are becoming increasingly
clinical in nature and can include a wide range of activities. Current
activities undertaken by pharmacy technicians, in collaboration with
pharmacists, include:
·
medication supply
·
checking medication in POD schemes
·
patient counselling and education, including the provision
of patient aids where appropriate, as well as medication charts and
monitored-dose systems to aid compliance
·
supporting patient self-medication
·
medicines information
·
discharge planning for patients, including communication
with primary care colleagues where appropriate
·
involvement in clinical trials and good clinical practice
governance
·
preparation of medicines formularies and guidelines
·
training and education
·
liaison with clinical teams on medicines management and
expenditure
·
AMS.
Whilst this last
subject will be addressed under strategic medicines management (Chapter 11), it
is important to note that AMS was the first ever clinical pharmacy programme to
receive national, ring-fenced, governmental funding. The importance of AMS is
highlighted in national reports and is enshrined within statute in the Health
and Social Care Act 2008. Guidance for compliance with criterion 9
states that healthcare providers ‘have and adhere to policies, designed for the
individual’s care and provider organisations that will help to prevent and control
infections’. Notably:
·
Local prescribing should, where appropriate, be harmonised
with that in the British National Formulary. Local guidelines for primary and
secondary care should be observed
·
All local guidelines should include information on a particular
drug’s regimen and duration.
·
Procedures should be in place to ensure prudent prescribing
and AMS. There should be an ongoing programme of audit, revision and update. In
healthcare this is usually monitored by the antimicrobial management team.
A systematic team
approach to AMS should be adopted in all healthcare institutions in order to
ensure optimal use and minimum toxicity in the use of antimicrobials.
Evidence-based standards should be agreed and form the basis of an education
programme for all users. Audit of the effectiveness of AMS should be regularly
undertaken and fed back to users for review and action.
Where empirical use
is considered a stepwise approach should be adopted:
Before an antimicrobial
is selected the following questions should be asked:
·
Is there an infection present? Physical and biomarkers must
be considered and, whilst many of these are non-specific, a number together can
indicate an infection is present. For example, CURB-65 is such a cluster of
markers commonly used in the diagnosis of community-acquired pneumonias. It is an
objective scoring system based on presence or absence of confusion, blood urea,
respiratory rate, blood pressure and patient age.
·
What is the likely organism?
·
Is it susceptible to antibacterial agents?
·
Will the selected agent reach the site of infection at the
required concentration?
·
Is the route of administration appropriate?
·
Is the duration of treatment appropriate?
·
Is there a stop/switch strategy?
The choice of agent
depends on a number of factors but the general principles behind selection are:
(1) only use an agent that is likely to work in the infection being treated;
(2) ensure that it is one that has the narrowest antibacterial spectrum; and
(3) ensure that the dose, route and duration of therapy are optimised. Ideally,
a laboratory sensitivity report should drive selection but intuitive choice can
be made from likely portal of entry. Once a sensitivity report has been
received then appropriate switching to a narrow-spectrum agent should be
promoted. Intravenous to oral switching should be made as soon as possible
using explicit agreed criteria. This can reduce both cost and complications and
allow patients to be discharged more quickly.
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