Putting antimicrobial stewardship in a global context

By Diane Ashiru-Oredope, Global AMR lead, Commonwealth Pharmacists Association

The independent Review on Antimicrobial Resistance estimated that at least 700,000 deaths each year globally are attributable to drug resistance infections such as bacterial infections, malaria and HIV/AIDS. Unless action is taken, it is thought the burden of deaths from AMR could balloon to 10 million lives each year by 2050 and cost the global economy up to $100 trillion US Dollars.

To help address this, the Department of Health, through the Fleming Fund, has just launched the new Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) scheme. This pioneering pharmacy-led initiative will send up to 12 volunteer teams of NHS pharmacists and specialist nurses to Ghana, Tanzania, Uganda and Zambia to work with local health workers to jointly tackle AMR. The scheme is now open for applications.

CwPAMS will help improve the detection and monitoring of resistant infections at the hospital level, take measures to reduce infection and put in place steps to use antibiotics effectively – all of which will help to keep antibiotics working better for longer whilst helping to stop the emergence of superbugs. The scheme is being led by The Tropical Health Education Trust and the Commonwealth Pharmacists’ Association (CPA) and is looking for multi-disciplinary approaches that involve pharmacy.

How will CwPAMS build capacity in AMS?

The CwPAMS programme will apply skills and knowledge from UK pharmacists to support capacity building for AMS in partner institutions. One important aspect of this is improving monitoring of antimicrobial consumption.

Robust monitoring mechanisms are required to help make informed decisions on where to focus efforts to reduce unnecessary use of antimicrobials, and assess the impact initiatives are having. Whilst monitoring both antimicrobial consumption is included in all national action plans on AMR, the capacity to implement this in most low and middle income countries is low. Enhancing monitoring capacity for AMS can also support building wider systems capacity and enable more effective stock control.

How will the CwPAMS scheme benefit pharmacists in the NHS?

There are important benefits for NHS pharmacists not to overlook when considering whether to apply, including:

  • opportunities to develop frugal yet innovative solutions to share with the UK 11/9/2018
  • improved leadership capacity
  • increased job satisfaction
  • improved understanding of digital technology in health
  • greater understanding and experience of working with limited resources and appreciation of the cost of resources within the NHS
  • opportunities for professional development.

How can you get involved and what support is available?

CPA are encouraging pharmacists to apply for this new and exciting opportunity. We recognise applying for grants can seem daunting to those not well immersed in doing so; the RPS are able to offer a range of valuable support in preparing applications. Contact the RPS Research Support Service or email research@rpharms.com.

CPA & THET will also be providing training for those who are awarded grants. To find out more visit the CPA website which includes access to the grant call documents. The grant call closes on 4 January. You can also email the CPA team directly via amr@commonwealthpharmacy.org.

 

Pharmacy breakthroughs in mental health treatment

By Julie Wakefield, RPS Museum volunteer

From the 1950s onwards there have been significant breakthroughs in the medicines used to treat mental health problems.

In the early 1900s the drugs used in psychiatry were the ‘chemical straightjackets’ such as opiates, bromides, and barbiturates that simply sedated patients.

This all changed in the 1950s with the introduction of chlorpromazine for psychosis, lithium for bipolar disorder, and imipramine for depression.

It began a pharmacological revolution because it demonstrated that drugs, not just psychotherapy, could restore mental health.

Antidepressants

Imipramine was the first of a class of drugs called ‘tricyclic’ antidepressants. In 1955, researchers gave it to 40 depressed patients. The results were dramatically successful. The pharmaceutical firm Geigy had produced the first drug in the history of psychiatry that acted specifically against depression.

Since then many more of these drugs have been developed, with varying side effects. However, imipramine is still considered by many psychiatrists to be the gold standard of antidepressant therapy.

Antipsychotics for Schizophrenia

Many pharmacy historians have regarded chlorpromazine as the single most important drug in the history of psychiatry. Chlorpromazine treated the symptoms of schizophrenic psychosis with less sedation than previous drugs.

A trial on 38 psychotic patients in the early 1950s showed that it could not only calm the patient but also treat a whole range of their symptoms. These included hallucination, delusions, confusion, anxiety states and insomnia.

Chlorpromazine was the first of a class of drugs called ‘typical’ antipsychotics for schizophrenia. A dopamine antagonist, it works by blocking the uptake in the brain of excessive levels of the neurotransmitter (a chemical that helps transmit signals in the brain) dopamine, believed to partly cause the symptoms of schizophrenic psychosis.

Bipolar Disorder

Just as chlorpromazine brought relief to sufferers of schizophrenia, lithium carbonate, launched in 1954, became the ‘gold standard’ treatment for bipolar disorder. Lithium is a mood stabiliser used in the prevention and treatment of mania associated with bipolar disorder (manic depression).It is still the most common treatment today as it both treats and prevents mood disorders.

The pharmaceutical treatment of mental health in 2018

However despite the significant developments in psychiatric medication over the last 70 years, many patients with mental health problems are still not receiving a high enough standard of care.

As part of its mental health campaign, the Royal Pharmaceutical Society is exploring how pharmacy teams can help improve the physical health of people with mental health problems.  People with mental health problems often have more difficulty accessing healthcare than others and the life expectancy of those with a serious mental illness is 15-20 years less than average.

A key part of improving this is ensuring patients get the best outcomes from their medicines, so reducing adverse events, minimising avoidable harm and unplanned admissions to hospital, while using resources more efficiently to deliver the standard of care that people with mental health problems deserve.

How pharmacists can support older people with mental health issues: a personal view

By Dr Amanda Thompsell, Chair of the Faculty of Old Age Psychiatry of the Royal College of Psychiatrists

Having met with members of the Royal Pharmaceutical Society to talk about their mental health campaign it made me reflect on the many ways that pharmacists support older people with mental health issues.

Not only do pharmacists give helpful advice around reducing unnecessary medications, on side effects and potential drug interactions and ways to improve adherence, but pharmacists help in so many other ways that can go unnoticed. Read more How pharmacists can support older people with mental health issues: a personal view

Improving mental and physical health – parkrun

By Chrissie Wellington, Global Head of Health and Wellbeing, parkrun

We all know that exercise is one way to improve physical and mental health, but it can be very hard to get started and motivate yourself to continue exercising.

I work for a brilliant organisation called parkrun which provides a fantastic way for anyone to improve their physical and mental health in a fun and supportive environment.

As a non-profit organisation, parkrun organises free 5k runs which take place every Saturday at 9am (9:30am in Scotland and Northern Ireland). There are currently over 770 parkrun events across the UK with approximately 140,000 weekly participants supported by around 14,000 volunteers.  Read more Improving mental and physical health – parkrun

Mental Health – awareness counts, action matters.

by Sarah Steel MRPharmS, RPS Wales Policy and Practice Co-ordinator

Sarah Steel MRPharmS, Policy and Practice Coordinator

Over recent years, mental health has become something of a global conversation, a buzzword, a hashtag. Remove the stigma. Break the silence. Be open, talk, share.

Awareness is fantastic, conversation is progressive but how we act is what matters. An episode of mental illness is frightening, frustrating and isolating. As a pharmacist and a patient I have seen mental ill health from both sides and both are scary. People involved on both sides are often scared about the same things. What is ok to say? How do I act? How do I not make this worse? Awkwardness can be destructive.

Admitted to hospital, as a patient in crisis it was exhausting being asked again and again by different people what medication I was taking. No, I didn’t bring with me the third lot of meds that my doctor has prescribed that right now aren’t helping me feel better. I desperately wanted to get better, but I especially wanted and needed to be treated as a person, recognised as a person at a time when I felt so much less than that.

Read more Mental Health – awareness counts, action matters.

It’s time to make the most of pharmacy in mental health

By Sandra Gidley, Chair of RPS England

People with a serious mental illness die 15-20 years earlier than on average.

They are three times as likely to lose all their teeth.

More than 16 million people in England are diagnosed with a long-term physical health condition, and more than five million of them will experience a mental health problem.

These are just some of the shocking figures that underline just how much further we have to go on the issue of mental health and the reason I was delighted to join with members, patient groups and the other health professions to mark the launch of the Royal Pharmaceutical Society’s new campaign on mental health in Parliament last week. Read more It’s time to make the most of pharmacy in mental health

Care homes: pharmacists and technicians working together

By Wasim Baqir, Medicines optimisation lead for care homes, NHS England

At NHS England I’m responsible for making sure the recently announced new roles in care homes – 180 for pharmacists and 60 for pharmacy technicians – get up and running and the necessary training is in place. But why work in a care home in the first place?

I’ve spent many years working in care homes in Northumbria. Pharmacists and technicians working together in care homes is a fantastic opportunity to drive up standards of safe, high quality care.  In addition, the job satisfaction is enormous.  You get a personal sense of achievement when you stop medicines which are unnecessary and harmful, when you stop waste that’s costly to the system, and work together across boundaries with your community, hospital and general practice colleagues to offer more to residents. Read more Care homes: pharmacists and technicians working together

What are the benefits of having a pharmacist in a care home?

By Sandra Gidley, Chair of RPS England

I’m delighted that NHS England, through the Pharmacy Integration Fund, have invested in creating 180 new jobs for pharmacists and 60 for technicians in care homes across the country.  There are huge benefits for residents in having a pharmacist involved in reviewing their medicines.

The average age of residents in care homes for the elderly is now 85 and they are prescribed an average of 7 or 8 medicines a day, though there are many are on more than that.  Those medicines can bring side-effects which in turn lead to loss of quality of life, so by rationalising those medicines, very often reducing the number taken, people feel better and the NHS saves money too.

Team work

Integration is a new buzzword which is the direction of travel for NHS delivery of health services. Pharmacists and technicians are a key part of the multidisciplinary team of GPs, nurses, geriatricians, and care home staff that look after residents. We need to all work together to provide residents with specialist clinical medication reviews to keep them from harm and keep them out of hospital. Here’s a great example of a care home pharmacist who is part of these reviews in the E & N Hertfordshire vanguard programme.

Residents’ relatives are also vital to such reviews and a very positive consequence is that their relationships with their loved ones often improve as a result of medication changes as the resident feels better and can be more communicative. The overall results in E&N Herts are astounding.  Since December 2015, their care home pharmacy team reviewed 1,426 residents and 13,786 medicines, stopped 2,238 unnecessary medicines including 681 with a falls risk, saved £354,498 in drug costs and an estimated £650,000 in hospital admission costs. They’ve also made a video about the way the vanguard programme was set up and the impact it had.

Challenging ourselves

By investing in pharmacists, commissioners are investing in their older, vulnerable populations and in better outcomes for patients.  By challenging ourselves to work in different ways and across traditional boundaries, we can grow as professionals, be part of a new way of working that enables us to demonstrate the benefits pharmacy can bring and deliver a better standard of care than ever before. It’s not always easy to do this, but it’s essential. Provision of services by pharmacists across settings is the game changer that NHS organisations are working towards.

Our Regional Liaison Pharmacists

RPS England has just appointed four Regional Liaison Pharmacists, who will be approaching local Sustainability and Transformation Partnerships amongst others to ensure they understand the contribution that pharmacists can make to the health needs of their local populations and so provide services that fit local needs. They will also discuss new integrated ways of working and ensure that pharmacists are part of this, including these new opportunities in care homes.

New jobs

I’ve received many requests for information about the new roles in care homes and these are still being worked on by NHS England.  I suggest keeping an eye on www.jobs.nhs.uk and of course the RPS will keep you up to date on developments.

 

Working at system level on care homes

by Wasim Baqir, National pharmacy lead on care homes, NHS England

NHS England has announced 180 new jobs for pharmacists and 60 for pharmacy technicians as part of the drive to improve patient care and the use of medicines in care homes.  At a system level, here’s how it will work – and I promise, it’s not as hard as it sounds!

STPs/ICS

The NHS and local councils came together in 2016 to form 44 Sustainability and Transformation Partnerships (STPs) with a vision to improve health and care for local people across whole areas rather than individual organisations. Following on from the Vanguard programme, the NHS announced 10 Integrated Care Systems (ICS) that have been given greater operational and financial autonomy to manage their services. Read more Working at system level on care homes

No you don’t need a PhD to pursue a career in the Pharmaceutical Industry!

Professor Luigi G Martini FRPharmS, FEIPG, Chief Pharmaceutical Scientist for the Royal Pharmaceutical Society.

Nor do you need to have done an Industrial pre-registration programme either! These are the two most commonly cited questions, or should I say myths, which are often directed at me.

So I have taken the opportunity in this blog to dispel a few myths as follows:

1) You do not need to have a PhD to work in industry, but it does help if you want to work in Research and Drug Discovery. However, there are many roles in Product Development, Manufacturing and Commercial which exist for pharmacists.

2) You do not need to undertake a pre-registration year in industry, and with only 11 such programmes in the UK, they are highly competitive and thus restricted with respect to demand. In fact, pharmacists who have trained and worked in community and hospital are highly regarded by the industry.

3) There has never been a better time to join the industry with pharmacists being highly desired for career paths in Medical Affairs, Regulatory Affairs, Pharmacovigilance and Quality Assurance.

Read more No you don’t need a PhD to pursue a career in the Pharmaceutical Industry!