Pharmacy teams are important members of the multi-disciplinary teams responsible for the treatment and care of myeloma patients but are not always part of clinics. Chesterfield Royal Hospital has found that integrating a pharmacist into their weekly myeloma clinics has led to improvements in the clinical service and patient satisfaction.
Rebecca Clark, Principal Haematology-Oncology Pharmacist at Chesterfield Royal Hospital shared her team’s experience of their increased involvement in patient care and how they introduced pharmacy-led clinics at Chesterfield Royal Hospital.
Myeloma patients often have complex treatment regimens which, alongside treatment for other co-morbidities and risks that accompany oral systemic anti-cancer therapy (SACT), require patients to have a thorough understanding of their treatment plan. To manage the growing complexity, the clinical pharmacy team at Chesterfield Royal Hospital became one of the earliest adopters of pharmacy-led clinics, a concept which has grown in recent years.
Implementing the pharmacy-led clinic
Pharmacy-led clinics were implemented at Chesterfield Royal Hospital following an evaluation of the local haematology and oncology clinical service. Beginning in 2009, the service was introduced through two main phases (1) introduction of pharmacist verification clinic and (2) expansion of clinic to include pharmacist prescribing.
The first phase was to move high-risk medications like SACT to a more controlled clinic environment. These would be verified by a specialist haemato-oncology pharmacist who has direct access to patient medical records, medical/nursing colleagues and the patient. This was instigated after the MDT discovered that many SACTs, prescribed by the consultant, were checked by non-specialist pharmacists in the main pharmacy dispensary, with the multiple interruptions associated with a busy outpatient environment.
The second phase was an expansion of the clinic to include pharmacist prescribing. This meant pharmacists could manage the administrative burden of the new treatment options by organising extra blood tests, requesting additional monitoring (e.g. ECG as required) and ensuring funding for expensive treatments was in place via the Bluteq system (online record management system). The expansion followed a prescribing audit which showed that, due to the numerous tasks consultants are responsible for in a short appointment, there was limited time to prescribe a complex treatment regimen. This data provided the business case for the haematology team to convert part of their funding for consultant hours into two clinics of additional pharmacist hours to manage the full prescribing of SACT on the electronic prescribing system. This freed up time, enabling the haematologists to focus on complex patients.
The team are now hoping to expand the clinic by developing a role for a specialist pharmacy technician and enhancing the role of the prescribing pharmacists to include reviewing and assessing a patient’s fitness for further cycles of SACT.
Benefits to patients and staff /Patients also see a benefit
Having a prescribing pharmacist in the clinic means they can review patients’ SACT prescriptions and their regular medications, checking for interactions, while also discussing any toxicities or issues patients may be having from their treatment. This allows the pharmacist to make alterations to supportive medications, such as anti-emetics, which can reduce the impact of side effects and improve the patient experience. Patients particularly appreciate the provision of a bespoke compliance chart, to assist them in taking their medication correctly.
Due to the nature of myeloma and new treatment options available, having pharmacy input in clinics enables patients to build valuable relationships with the pharmacists. It is also rewarding on a professional level for the pharmacy team, who get the opportunity to be directly involved in patient care.
A multidisciplinary approach to the clinic is essential
Establishing the pharmacy-led clinic was not without challenges. Clinic room availability and securing funding were the two biggest obstacles to overcome. However, strong support from across the MDT and commitment to internal evaluations of the service ensured there was support and evidence for a robust business case. Rebecca and her team also benefited from excellent relations with the nursing and medical teams, who recognised and supported the benefits of having a clinic-based pharmacist.
The support for pharmacy-led clinics grew quickly. After a short trial in one clinic, the benefits to patients, nursing, medical staff, and medication safety were evident. As a result, during a relocation of the haemato-oncology clinic, a room was reserved for the pharmacist role in recognition of their highly valued contribution to the haematology clinic team. In fact, pharmacy input was sought during the planning for the construction of the new unit.
Suzanne Renwick, Healthcare Professional Projects Manager said:
“Chesterfield Royal hospital were awarded their CSEP accreditation in November 2019. What the team at Chesterfield Royal Hospital have demonstrated, is a positive form of task-shifting in the clinical service which has not only benefited patients and improved their experience but has also improved the safety, cohesiveness and efficiency of the haemato-oncology MDT and overall increased job satisfaction.”