Q&A
IN thIS ISSUE, thE UcA’S phARmAcISt REpRESENtAtIoN gRoUp, whIch woRKS oN BEhAlf of All pRImARY cARE EmploYEE phARmAcIStS, pUtS ItS tEN QUEStIoNS to pEtER ARmStRoNg, lEAD IN thE mAcmIllAN pAllIAtIVE cARE phARmAcY SERVIcE ImpRoVEmENt pRoJEct.
tEN QUEStIoNS
tEll US ABoUt YoUR RolE AS lEAD IN thE mAcmIllAN pAllIAtIVE cARE phARmAcY SERVIcE ImpRoVEmENt pRoJEct AND whAt thIS INVolVES oN A DAIlY BASIS.
the transforming Your palliative and End of life care (tYpEolc) programme, led by the marie curie and the health and Social care Board, identified palliative care pharmacy as one of eight areas to be developed under the initiative. the subsequent palliative pharmacy design group, co-chaired by macmillan cancer Support, looked at ways of improving existing pharmacy services and developing better ways of working that would lead to improvements in the care for patients with palliative needs. macmillan saw the value in the service pharmacists can provide and agreed not only to fund a pharmacy service improvement project, but also to provide their ongoing expertise, training and support to the project team.
the team consists of a pharmacist in each of the locality areas. our core objectives are around improving access to palliative medicines, facilitating hospital discharges to ensure continuity of care, anticipatory prescribing at the end of life and education and training. we are looking at innovative ways we can make an impact in these areas.
my days can be quite varied; I could be out providing training, promoting the project and the role of the pharmacist in palliative care, or linking in with the team on our various works streams. we meet regularly using videoconferences to support each other and ensure our progress. currently I am planning a pilot of ‘Just in case’ boxes in community settings in Belfast and fermanagh. these boxes are designed
10 - phARmAcY IN focUS
Seeing at first hand the benefits good palliative care provides for patients and carers has given me skills and confidence to take into my current role. I have also worked on various surgical and medical wards as a hospital pharmacist and as a locum pharmacist in community pharmacy in a few rural locations in Australia, which was a fantastic experience.
YoUR RolE mEANS DEAlINg wIth A lot of SADNESS. whAt IS YoUR fAVoURItE pARt of YoUR JoB?
to hold any medicines that might be needed at the end of life in the event of symptoms such as pain and agitation occurring and are placed in the patient’s home ahead of this time. they will also provide reassurance to carers that any medication that may be needed is already in the home.
hAS thE Roll-oUt of thE REgIoNAl cENtRES BEEN SUccESSfUl to DAtE? whAt SUppoRt cAN thE pAllIAtIVE cARE phARmAcIStS gIVE to Both commUNItY AND pRActIcE- BASED collEAgUES?
the palliative care service improvement pharmacists can act as a link for community/federation pharmacists, bridging the gap between primary and secondary care and addressing any issues or concerns around palliative care medication. through recent meetings with community pharmacists we have
identified that the prescribing of lower strength midazolam injections can cause delays in patients accessing it and difficulties for district nurses when they are administering it to patients. we have since been liaising with federation pharmacists and are looking at ways of working with them to ensure the preferred 10mg/2ml strength is prescribed. we hope that some of the other initiatives we have planned, especially around hospital discharges, will reduce the workload of community and federation pharmacists and improve the service delivered.
IN whIch othER AREAS of phARmAcY hAVE YoU pREVIoUSlY woRKED BEfoRE tAKINg oN thE RolE AS pAllIAtIVE cARE lEAD?
my background is in hospital pharmacy and, before this role, I was the specialist palliative care pharmacist at the marie curie hospice and in Belfast city hospital.
Being involved in palliative care is a very positive experience. we focus strongly on quality of life for patients and their loved ones, whether their prognosis is days, weeks, months or even years. If I can play a part in helping patients manage their medicines to enable them to attain their goals, then that is a very rewarding experience. Recognising dying is an important aspect of palliative care and most people want to die at home whereas, at the minute, the majority of people die in hospital. If we can control patient symptoms by providing advice on and access to appropriate medication at the end of life, which enables them to stay at home, that is very satisfying. Even small things like explaining to patients and carers how to use their breakthrough pain medication effectively can make a big difference to their lives and facilitate normal everyday activities, like walking the dog or meeting friends, that are very important to people.
how woUlD YoU lIKE to SEE thE RolE of thE phARmAcISt pRogRESSINg wIthIN pAllIAtIVE cARE?
we say that palliative care is everyone’s business and I would like to promote palliative care to all
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