by Elin Gwyn MRPharmS, Palliative Care Pharmacist, Betsi Cadwalladr Health Board
The latest meeting of the Welsh Assembly’s Cross Party Group on Hospice and Palliative Care was recently held at on Friday 23rd November. Royal Pharmaceutical Society in Wales asked me to attend the meeting on its behalf. With RPS having just recently launched its policy on palliative and end of life care, its engagement and membership of this group is very timely.
The purpose of cross party groups is to bring together groups and organizations with expertise in a particular policy area with Assembly members who are interested in the same area. The cross party groups don’t have power, but they are used to raise Assembly members’ awareness of issues related to the field so that they can scrutinise and challenge the government and the NHS more effectively.
It’s long been recognised within prison populations that there’s a high prevalence of substance use disorder in connection with prescription medicines. This is often found alongside problematic polypharmacy situations.[i] My main objective as a Lead Prison Pharmacist is to optimise medicines and resolve problematic polypharmacy, to try and rehabilitate people held in custody.
Medicines optimisation within a prison takes many forms, just as it does in other areas of health care. It starts with comprehensive medicines reconciliation when people arrive at the prison. Compared with the general population, people in custody have often lived chaotic lifestyles, either on the outside of prison, or perhaps in other prisons, so the first step is to understand what they have been taking, and how they have or have not been managing their medicines.
A particular problem we encounter during medicines reconciliation is that when a person arrives in prison, they often have other people’s prescription medicines in their possession, as well as their own. This forms important evidence for any resulting medicines optimisation.
by Darrell Baker FFRPS, Chief Pharmacist and Clinical Director of Pharmacy and Medicines management for Cardiff and Vale University Health Board
A good life to the very end…
“For human beings, life is meaningful because it is a story, and in stories endings matter”
Quality palliative and end of life care is important and medicines can have a key role to play in facilitating that quality of care for many of our patients. On behalf of the Chief Pharmacists in NHS Wales, I am pleased to have supported the development of the RPS Wales policy document and to endorse its key recommendations.
Focusing on the individual
Understanding what quality end of life care looks (and feels) like for an individual is an important starting point. Pharmacy staff need to work as integrated members of the multi-professional team around the patient, with access to clinical information about the patient. This way, we are able to respect their wishes and support effective implementation of treatment and symptom management plans, regardless of location.
If asked to list influential figures in the history of the First World War, few would probably know the name of Edward Frank Harrison. But it was Harrison who was responsible for saving the lives of thousands of Allied soldiers thanks to his work to combat the threat of chemical warfare.
Born in 1869, Harrison began his career as an apprentice pharmacist in North London aged 14. He was awarded the Pharmaceutical Society’s Jacob Bell Scholarship and won prizes in the subjects of chemistry, botany, and materia medica. He passed both the Minor and Major examinations at the Society’s School of Pharmacy and registered as a pharmacist in 1891. Read more Edward Frank Harrison – a pharmacy war hero ›
by Dr. Idris Baker, National Clinical Lead for Palliative and End of Life Care in Wales
Are you serious?
“Are you serious about this? Who do you think you are?” the out of hours coordinator asked me. “Sending a man like this home? Asking for morphine for him to go with? A man like this needs to be in hospital.”
The problem was that Bill – he wasn’t “a man like this”, he was this man– didn’t want to be in hospital. He was in A&E, and he was screaming, and he could only tell me two things: he wanted painkillers, and he wanted to go home. He only had these two wishes and he hoped I could grant him both.
His family filled in some blanks. Bill had advanced pancreatic cancer, his chemotherapy hadn’t worked, and he knew – they all knew – that he was dying. No one had given him any decent painkillers. It had got so bad that they had to bring him to hospital. We had old hospital notes and it all checked out, so there was nothing suspicious about the story. Bill was dying, in pain, and scared. I was scared too, a new young casualty officer facing a long bank holiday weekend, and I didn’t know much but even I could grasp a bit about Bill’s situation.
by Sudhir Sehrawat, Community Pharmacist and RPS Welsh Pharmacy Board member.
Getting it right – first time.
In every day working life we strive to get things right so we achieve the results that people need. It saves time, avoids duplication of effort and you get the result you want. Yet, as a community pharmacist, I see palliative care as an area where we sometimes don’t get things right first time due to the complexity of the systems and processes involved.
What happens when we get it wrong
In a real life scenario I was presented with a prescription by a patient’s relative for end of life medication on a Saturday morning. The medication prescribed was not on the Health Board Palliative Care Formulary and the family had spent most of the previous day travelling to various community pharmacies to get the prescription dispensed. I contacted the out-of-hours GP explaining the situation and the relative was asked to attend the out-of-hours service for a new prescription. They returned after lunch with a new prescription, however, the hand written prescription did not meet the controlled drugs regulations. I contacted the out-of-hours service again and the family member was asked to pick up a new prescription and return to the pharmacy. The controlled drug was supplied in part due to limited stock held but was enough to last until Monday evening. I explained we could order the remaining stock and deliver it when it arrived. After work on Monday evening I visited the patient’s address with the remaining medication only to discover the patient had sadly, already passed away on Saturday evening.
When a patient is at end of life members of the family and friends need to be with their loved ones, not chasing supplies of medication.
There’s lots to consider within this one real life scenario.
Why was a non-formulary palliative care medication prescribed?
Why was the alternative controlled drug prescription not written correctly?
Where were the communication channels to let the community pharmacy know the patient had passed away?
This single case is typical and highlights multiple opportunities to improve care at the end of life.
Getting it right in future
I welcome the upcoming policy on palliative and end of life care by the Royal Pharmaceutical Society in Wales. This leading policy will address the issues we healthcare professionals face and importantly, allows patients high quality coordinated care. Patients and carers have the right to be treated with dignity and respect. The policy outlines key areas to ensure patient empowerment through timely access to medication, providing the right support through shared health care plans and offering education and training to the workforce.
If we work on an All Wales approach and implement the key recommendations of the policy, we have the opportunity to drive quality improvements as well as reduce demands on our health and social care services. I’m fully behind the policy as I hope many of you reading this blog will be. Lets get it right – first time.
I have just retired, having had a very rewarding career as a palliative care pharmacist. I firmly believe pharmacy has a key role to play in supporting patients and their families, as well as other professions, in the delivery of palliative care services in both community and secondary care. Currently we are an under used resource but have the potential to offer much more to existing services.
Community Pharmacists are ideally placed to advise on the safe and effective use of medicines. The local pharmacist is a readily accessible source of information and advice for both the patient and those supporting them. With improved communication with fellow professionals in both the community and secondary care services they would be better placed to ensure the supply of essential medication and support. This in turn would help community services in supporting patients who wish to die at home.
In secondary care the inclusion of an advanced specialist pharmacist in the palliative care multidisciplinary team is beneficial in providing advice on all aspects of medicines management from the suitability and availability of drugs and the prescribing options to the use of drugs in renal and hepatic failure. Non specialist pharmacists also have a role in ensuring symptom control is optimised, appropriate and effective.
For pharmacists to reach their full potential in the field of palliative care they need access to education and, where appropriate, the opportunity to gain experience in working with palliative care patients.
The scope of palliative care includes many non-cancer diagnoses and, with an ageing population, there are more patients requiring palliative care input than ever before. Pharmacy needs to rise to the challenge. We have made a start in Wales and have formed the All Wales Palliative Care Pharmacist Group, for pharmacists with a particular interest in palliative care.
*The group undertakes projects on a national basis such as the Just in Case Box scheme and the development of the syringe driver chart and also acts as a support group for its members.
We need to build on these foundations to ensure pharmacy provides great care for palliative care patients and continues to develop expertise in palliative care medicines use across the whole range of pharmacist roles
by Jodie Williamson, Professional Development and Engagement Lead at the Royal Pharmaceutical Society in Wales.
Last week 3000 pharmacists from 108 different countries came together in Glasgow for the International Pharmaceutical Federation (FIP) World Congress. This is a conference where pharmacists from around the world can share advances and developments from their country with an international audience in order to improve the benefits patients get from their medicines on a global level. With RPS hosting this year’s conference, I was lucky enough to attend and represent our team in Wales. FIP World Congress last came to the UK nearly 40 years ago, so getting to attend the conference so close to home was a once-in-a-lifetime opportunity for me.
We know that healthcare systems around the World are facing increasing pressures and demands on their services and this resulted in a real sense of the need for pharmacy services to change amongst all delegates. It was an eye-opening week for me!
I learnt about how community pharmacists in Portugal are now working with general practices to offer early screening for a variety of conditions and are able to refer patients directly to the most appropriate services if a condition is identified, relieving the pressure on their GPs. They also run clinics with nurses and nutritionists to offer advice about diet and nutrition on the high street and now their patients are calling for them to be able to request blood tests and interpret their results. Community pharmacies are the first port of call for most healthcare needs in Portugal.
I also attended an emotive and thought-provoking session on death and dying. We heard from countries where euthanasia has been legalised about the role of pharmacists in the process and how they are trained and supported to deliver excellent end-of-life care. The session challenged my thinking around the guiding principle for healthcare professionals to do no harm. An excellent quote that resonated with me during the session was “sometimes death ends suffering, not life”.
On the other hand, the conference also made me realise how lucky I am to be trained and practicing in the UK. Our healthcare system, the quality of our training and development, and the standards that we work to are the envy of so many pharmacists from around the World. Whilst I learnt a lot from other countries a number of our Welsh pharmacists were also presenting their innovative work. From our community pharmacy Discharge Medicines Review (DMR) service to developments in cancer care at Velindre Cancer Centre, our pharmacists are doing an excellent job of putting Wales on the map as leaders of the profession on a global scale!
by Dr. Claire Thompson, RPS Deputy Chief Scientist
I’ve written lots of blogs on science or leadership but never about being gay, so this is my first professional outing.
I’m fortunate in that I have never experienced overt homophobia in the workplace. This is in stark contrast to my personal life, where experiences have ranged from:
– Being abandoned by groups of friends at school;
– Family members not coming to my wedding because they didn’t “agree with it”; and
– Strangers in the street shouting “You deserve to die” for simply holding hands with my girlfriend. (No, this wasn’t the 1950s, it was 2003)
Even though they haven’t been painful professional experiences, it doesn’t mean there haven’t been uncomfortable ones. Like every time someone asks “What does your husband do?”. I’ve lost count of the number of times I’ve responded “They….” or “My partner….” Because I didn’t want people to feel uncomfortable or embarrassed. But the longer you leave it, the more uncomfortable the discussion gets.
When is the right time?
So, when is the right time to say “She” or “My girlfriend” or “My wife”? Over the last few years, I’ve made a conscious decision to get “She” in early. The birth of my daughter really helped with this. As a proud parent, I would show people photographs and they would say “You look great for having a young baby” to which I could respond “Oh my wife gave birth to her, and she looks better than I do!” (See the photo below as proof). I find that openness, humour and a baby photo go a long way to diffusing any discomfort. Of course, there have been occasions where I have just taken the compliment (please don’t tell my wife)!
Coming out to colleagues still doesn’t come naturally, it always takes an element of bravery and I do admit that there are some people that I still don’t tell because I know they will judge me unfairly. Ultimately, we need to be comfortable with what we share about ourselves.
But if you do want people in the workplace to know that you are gay, take a deep breath and go for it.
Be brave. Be you.
by Sarah Steel MRPharmS, RPS Wales Policy and Practice Co-ordinator
With August being the month we in Wales choose to celebrate Pride, what better time for the RPS Wales team to join the ongoing campaign for unity, equality, acceptance and embracement. To show our solidarity, some of our RPS staff members will be sharing their experiences in pharmacy as members of the LBGT community, and on the 24th of August, the eve of Pride Cymru, in the office we will be donning our brightest colours, eating rainbow cakes and flying the flag in support of Pride.
Why we still need to worry about equality
I’ve found myself thinking recently – if last year marked the 50th anniversary of the 1967 Sexual Offences Act and the “de-criminalisation of homosexuality”, why are members of the LGBT community still being tormented, isolated and discriminated against? It turns out, my ignorance was distorting my understanding. In 1967 homosexuality was in fact only partially de-criminalised; many anti-gay laws remained, and criminalisation did not in fact toally end in the United Kingdom until 2013. That’s only five years ago!
Five years ago, I was in my second year of University. Through my time at University and my career to date, I have been a proud member of the LGBT community. For the majority of the time, I have felt accepted and embraced, but I can’t say I have always felt that I am, or would always be, treated the same. My sexuality is something I am conscious of in interviews, when starting new jobs or working in new teams. I am still, in 2018, worried how people will react when, for example, I correct he to she when talking about my personal life. And I am sad to hear from colleagues and friends that they have had much worse experiences, including homophobic slurs and discrimination.
Join us and show your Pride in Practice
What stands out to me clearly is that LGBT rights and support is not a moot point, and there’s still a long way to go. The celebration of the campaign and the achievements so far is as important as ever, and we hope that through our blogs and photos, we can be a part of the campaign for unity, equality, acceptance and embracement for all of our members. We’d love it for members to join us by sharing photos of your involvement this weekend, either at home or in the work place. Be sure to tag your social posts with #RPSPrideInPractice so we can share!
About the RPS blog
The Royal Pharmaceutical Society is the dedicated professional body for pharmacists and pharmacy in England, Scotland and Wales.
Our blogs are written by experts and provide thought provoking information and commentary on health, health policy issues and lifestyle choices. Here you will find opinions and comments on topics related to public health and medicine safety.
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