Can pharmacists help ease emergency workload?

In 2016, most UK Accident and Emergency Departments were facing a large and growing workload – so pharmacists were examined as a solution

A study published in Integrated Pharmacy Research and Practice set out to identify and describe the most effective model for managing, educating and training pharmacist advanced clinical practitioners (ACPs) in the urgent care centre setting, describe how the role evolves during the training period, and identify how best to measure its effectiveness.

Urgent care centres (UCCs) had been introduced by NHS England in 2015, to enable patients to receive timely review by a primary care clinician.

Many were located within A&E departments, to reduce pressure in those areas.

The Health Education England (HEE) started up a project which would see three A&E departments in England’s south-east each employ between one and five pharmacists in their UCCs.

The pharmacists, while working in the departments as trainee pharmacist ACPs, were funded to undertake advanced clinical practice training18 and independent pharmacist prescriber training.

Cinical supervision and training were provided by medical practitioners and senior ACPs within the A&E department.

Focus groups with the pharmacist trainees were undertaken at one, three, six and 12 months, while non-pharmacist staff also undertook interviews after three months.

Five themes resulted from the combined analysis of all the data: management, communication, education and training, role definition, and outcomes.

“This is the first paper to describe the integration of pharmacists as ACPs into UCCs with an expectation that they undertake a similar caseload to that of medical practitioners and other ACPs working within the area,” the authors write.

“The research suggests that it is feasible for pharmacists to be educated and trained to work within the area. Additionally, they can assume some of the workload while providing the benefit of immediate access to their pharmaceutical expertise.”

There was some initial scepticism about pharmacists working in this role, and “artificial barriers created due to a lack of awareness of role and funding source”.

However by the end of the evaluation there was widespread acceptance of the pharmacists.

“It would be reasonable to assume that pharmacist ACPs will make a significant contribution to local workload,” the authors wrote.

The researchers concluded that to be successful in this role, pharmacists would need to have the right attributes: that they be experienced, proactive, organised and resilient.

“Furthermore, the amount of work required to both the learner and department should not be underrepresented.”

The trainees were initially best located in the minor illness area.

“Patient satisfaction combined with a number of process measures such as number of patients seen, readmission rate, and medicines-related problems addressed was an appropriate method for capturing the effect of pharmacist ACPs.

“Acceptance of pharmacists within UCC by other professions was widely identified, as was the recognition that after 12 months, they were making a positive contribution to workload.

“The accessibility of pharmaceutical knowledge was an added benefit. Once trained within this area, staff acknowledged that ACPs might be able to make a wider contribution, particularly in primary care.”

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