Clinical pharmacy service evaluation of hepatology services at a large tertiary centre
Authors: Shah S , Elhag S 
Published: November 2022

Introduction

Kings College Hospital (KCH) provides tertiary level care to patients with liver disease across the UK. These patients are often under the joint care of primary and/or secondary care centres. As a result, several medications related enquires are received from patients and healthcare professionals including, doctors, nurses, and pharmacists to continue and optimise pharmacotherapy. The KCH liver pharmacy team does not provide a formal medicines information service, although a large amount of pharmacy resource is used to provide high level medicines information locally, regionally, and nationally by the team. In addition, significant time and input is provided in optimising access to hospital only medication.

Aim

To describe activities conducted by a specialist clinical pharmacy team out with an inpatient or formal outpatient setting which contribute to medicines optimisation and improve access to specialist medication.

Methods

Retrospective data collection was carried out over 2 separate four-week periods in November 2020 and November 2021 by the specialist liver pharmacy team. The data was analysed on an 8-week average using Microsoft Excel. Ethical approval was not required as this is a service evaluation data collection.

Results

Over eight weeks, the specialist clinical pharmacy team (pharmacists and pharmacy technicians) received 206 queries, of which (72%) were received by email and (28%) by phone. The team spends an average of 15 hours per week on clinical activities outside of formal inpatient and outpatient settings. Most of the queries received were from patients (64%), followed by healthcare professionals including doctors (11%), nurses (9.5%), and pharmacy staff (7.7%). The clinical interventions made by the team included supply of medications (37%), prescribing events (36%) and medicines intervention (20%) which included drug selection, administration, optimisation, deprescribing, therapeutic drug monitoring, drug-drug interaction, transfer of care and advice given following adverse drug reactions.

Discussion/Conclusion

The ease of accessibility to the specialist clinical pharmacy team plays a significant role in providing access to specialist medications to patients and a positive impact on other healthcare services, including decreasing the burden upon primary care. A structured medicines information line provided by the specialist team would be effective for patients and healthcare professionals as the specialist team spends substantial amount of time providing medicines intervention and medicines information. The involvement of specialist pharmacy technicians in medicines information services and interventions, provides an opportunity for role development and up-skill the pharmacy technician role in a specialist team. A formal and structured medicine information service for hepatology by the specialist clinical pharmacy team should be considered to improve access to specialist medication and medicines optimisation.

References

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2. Hayward K, Patel P, Valery P, Horsfall L, Catherine L, Penny W. Medication-related problems in outpatients with decompensated cirrhosis: opportunities for harm prevention. Hepatology Communications, 2019;3(5):620-663.

3. Newby B. Expanding the role of pharmacy technicians to facilitate a proactive pharmacist practice. American Journal of Health-System Pharmacy, 2019;76(6):398-402.