The role of pharmacy technicians in clinical pharmacy services

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Chapter: Hospital pharmacy : Clinical pharmacy

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.


Antimicrobial stewardship


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:


Is there an infection?


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?


Which antimicrobial?


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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