Case study: IBD Specialist Pharmacy Service, Brighton & Sussex University Hospitals Trust

Case study: IBD Specialist Pharmacy Service, Brighton & Sussex University Hospitals Trust

Pharmacist-led clinics are being established in a wide range of specialities and widely reported. However, no reports have been identified of embedding pharmacy services fully into the specialist service taking on long-term care.

Highly specialised pharmacists make independent decisions on all therapy areas but now need to move their pharmaceutical core competencies out of the pharmacy environment into the whole provision from the service.

The new IBD Standards recognise the importance of the specialist pharmacist within the multidisciplinary team and their role within the patient journey, from new diagnoses to inpatient care.

Statement 1.4

The IBD leadership team should work with an expert pharmacist in IBD to ensure good medicines governance, including medicines optimisation and cost-effectiveness.

Statement 3.2

All newly diagnosed IBD patients should be seen by an IBD specialist and enabled to see a gastroenterologist/paediatric gastroenterologist, IBD nurse specialist, specialist gastroenterology dietitian, surgeon, psychologist and an expert pharmacist in IBD as necessary.

Statement 6.10

All IBD inpatients should have their prescribed and over the counter medications reviewed on admission by a pharmacist who has access to an expert pharmacist in IBD for advice, with regular review of medications during their inpatient stay and at discharge.

Who's doing it well?

Brighton and Sussex University Hospitals Trust have extended their specialist pharmacist’s remit and integrated a pharmacy-led comprehensive medication optimisation service for gastroenterology into the specialist multidsciplinary team (MDT).

The idea

Incorporating a pharmacist into the IBD team releases doctors’ time, as well as improving the consistency and safety of drug monitoring and counselling.

Alongside this, Brighton and Sussex University Hospitals Trust recruited a pharmacy technician to manage routine drug monitoring, amongst other duties, thereby freeing up pharmacists’ time.

The Specialist Pharmacist Project had 8 key objectives:

  • Provide an independent prescribing service initiating and monitoring drug therapies, which included establishing a weekly pharmacist outpatient clinic session alongside a supervising consultant clinic
  • Strategically and clinically manage the biologics infusion clinic with the technician managing the infusion preparation under the supervision of the specialist pharmacist
  • Provide a therapeutic drug monitoring service to individualise therapy, which involved the pharmacist optimising therapies for immunomodulators
  • Oversee the biosimilar switch, optimising therapies and leading to considerable cost savings and income through negotiations with commissioners
  • Establish a virtual biologic and immunosuppressant clinic (VBIC) with the pharmacist technician’s role within this to request IBD scores, faecal calprotectin and blood results from patients who were discussed in this clinic
  • Provide advice to patients on managing their condition and flare-ups, which involved sharing the telephone advice line with the IBD Nurses
  • Develop MDT and clinical commissioning group approved pathways to initiate and review immunomodulators, which were facilitated by the pharmacist in conjunction with audit tools
  • Assess workload impact, financial benefits and acceptability of service

Results

Impact on patient care

  • Enhanced patient safety through a managed drug monitoring service
  • Patients feel secure due to quality structure and specialist care
  • Provision of a sound governance framework for individualised medical therapies
  • Necessary drug therapy changes in outpatient and infusion clinics can be made in a timely fashion in conjunction with the patient
  • Minor ailments are addressed during attendance
  • Access to medical reviews when necessary
  • Cross-over cover with nurse guarantees helpline is reliably and competently staffed
  • Standardisation of patients work-up for immunomodulation
  • Standardisation of treatment optimisation
  • Standardisation and optimisation of patient information and consent
  • Database completed and updated

Impact on the multidisciplinary team

  • Increased focus on medicines optimisation by the specialist MDT
  • Increased focus on high quality and compassionate patient care by pharmacist
  • Free up clinic slots with doctors and nurses
  • Ensure routine monitoring visits are not missed
  • Interprofessional relationships profit greatly when working closely and deputising for each other
  • Novel ways of working explored
  • Early identification of savings and new ways of providing the service at a lower cost
  • Seamless care at minimal staffing with optimal competency levels ensured
  • Model of total integrated pharmaceutical care beyond clinics applicable to any speciality and can be used as a model for other professions involved in the multidisciplinary team

A competent pharmacy technician can safely take over most drug monitoring and preparation previously managed by the pharmacist, leading to projected cost savings of £13,000 (lower staffing cost) and £36,000 (vial sharing) per year.

In addition, nurses’ time was freed up and the pharmacist was able to deal with more complex patients.

References:

1A St.Clair Jones, M Smith. Embedding pharmaceutical care into the multidisciplinary team. ECCO 2015 Abstract P306.

2A St.Clair Jones, M Smith.Infliximab biosimilar switching program overseen by specialist pharmacist saves money, realises investment and optimises therapy. ECCO 2017 abstract P527.

3A Packham, A St.Clair Jones. Pharmacy Technician in the IBD team maintains patient safety whilst freeing up Pharmacist and Physician time. BSG 2018: PWE-0720