PALLIATIVE CARE


PALLIATIVE CARE:


AS MOVES ARE MADE AROUND THE UK TO HARNESS THE CLINICAL ExPERTISE OF COMMUNITY PHARMACISTS IN PALLIATIVE CARE, PIF LOOKS AT AN INNOVATIVE PALLIATIVE CARE SERVICE FROM NORTHERN PHARMACIES LTD.


P


harmacist David Marshall has a ‘two-pronged’ job. In addition to the two days a week where he


works as the pharmacist in Sweeney’s Pharmacy in Holywood, on the other three days David is based at the Marie Curie Hospice in East Belfast, providing an invaluable link at the interface with the hospice team, hospital and community pharmacists.


‘Northern Pharmacies have been providing a pharmacist to work in the hospice for three days a week for over three years,’ says Northern Pharmacies’ Superintendent Pharmacist, Michael Hamill. 'The Belfast Health and Social Care Trust had been providing a pharmacist at the hospice for two days a week for a number of years and so Northern Pharmacies Trust Fund - our charitable arm - approved an application for funding from Marie Curie for the other three days. The Trustees thought it would be good to become involved in this work and so we decided to fund David’s position.


‘Ideally we want the post to become a resource for all pharmacists involved in palliative care. The ultimate aim is that community pharmacists right across Northern Ireland can contact David with regard to issues such as dosages of palliative care medicines or, in the event of a shortage, to provide alternatives to the drug which has been prescribed. Being able to contact someone such as David with knowledge of syringe driver dosing and unusual items can prove invaluable when you are standing in a dispensary on your own.


‘David has a particular interest in palliative care pharmacy. He is working as part of the palliative care team in the Marie Curie hospice


which has provided valuable experience and insight into patient care. He has already attended various courses at Queen’s University in Belfast and, at present, is doing his independent prescribing qualification, so he is very well-informed about this particular area of pharmacy.


‘David’s ability to assist other community pharmacists will be increasingly required, mainly because, in addition to the current shortages, there are other problems linked to palliative care drugs. One of these challenges is the quotas issue.


afternoon, so I had to drive them up. This not only put me in a compromising position, ie, I shouldn’t be driving about with a boot full of controlled drugs, but, when we were trying to order the drugs through the wholesaler's sales team, we were told that we had hit our quota and this would have to be reset on the following Monday.


‘I had to make very strenuous efforts, including complaining to the management team about this, simply to get these essential drugs through. This should not be happening.


‘At all times the patient should come first, and in the case of a palliative care patient, that is even more the case’


‘Many terminally ill patients want to be discharged from hospital so that they can spend the time they have left in their own home or in the hospice. At the point of discharge, the hospital pharmacist may try to liaise with the community pharmacist with regard to the medication that the patient is supposed to be taking. There are often challenges presented by this handover, which can cause difficulties for the patient, their family and the community pharmacist.


‘On one occasion, a patient was supposed to be staying in the hospice, but was then allowed to go home and naturally required more drugs. We were deemed to have hit our quota for a particular line and ended up having to bring the drugs in through one of our other branches and take them to the Holywood branch. It was a Wednesday


‘We are lucky in that we have someone like David Marshall available to advise on alternatives etc, but it is incredibly difficult for those pharmacists, who are put in the position of either not being able to source palliative care drugs, or having the knowledge to suggest alternatives. It is for that reason that we intend to make David and our palliative care facility a resource for community pharmacists throughout Northern Ireland.


‘Shortages are becoming a real problem everywhere, but particularly in palliative care. David’s interface role creates flexibility in trying to sort shortages. Say, for example, a prescription is written for product ‘x’ and the supplier says that they don’t have any, or that we have met our quota of ‘x’. David knows palliative care drugs well and is able to ensure


that patient care is never compromised. Very often, if a pharmacist in the community does not know how to source a product or provide an alternative, then the pressure is put back on to the hospice or prescriber, and the deadline for afternoon delivery may be missed impacting on patient care.


‘Those, who are imposing these quotas on palliative care drugs, forget what these drugs do. For a start, they have a positive impact on end-of-life care. There shouldn’t be quotas on these drugs. Palliative care medicines are a niche, bespoke market that is driven by patient demand. Commercial considerations should not be part of the equation.


'On many occasions we only have one source for a particular drug and it is totally unacceptable for us to have quotas set by manufacturers for that drug, It clearly indicates that they do not recognise that these drugs are urgently needed by a patient. No one can predict the number of palliative care patients at any one time - or indeed the drugs and doses which may be required.


‘At all times the patient should come first, and in the case of a palliative care patient, that is even more the case. The hospice believes that patients should die in a pain-free, tranquil environment and we support that 100 per cent, but we need the appropriate drugs - with no delay - to ensure we can deliver that level of care. Every patient deserves it!’


For any community pharmacist with a palliative care query, David Marshall can be contacted through the Northern Pharmacies branch in Holywood on 028 90422222.


PHARMACY IN FOCUS - 27


Northern Pharmacies Ltd to establish ‘centre of excellence’


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