Me and My Pharmacy

Posted 6th March 2014

Helen Clark, Chief Pharmacist at The Clatterbridge Cancer Centre tells us more about the Pharmacy service at the Trust

• How would you describe your pharmacy/health centre (size, facilities, etc)?

The pharmacy department at The Clatterbridge Cancer Centre provides chemotherapy and supportive treatments to almost all solid tumour patients in Merseyside and Cheshire. Our MHRA (Medicines and Healthcare Products Regulatory Agency) licensed production unit provides approximately 6,000 injectable dose units for the provision of chemotherapy per month, 70,000 doses per annum. We have over 40 members of staff who are involved in the management of medicines costing over 30 million pounds and they provide clinical pharmacy services, education and training and are involved in pharmacy research and clinical trials.

The majority of treatments are prepared in advance of the patients’ arrival to reduce waiting times for patients attending clinics. Chemotherapy treatments are prepared centrally at The Clatterbridge Cancer Centre and delivered to chemotherapy clinics closer to the patients’ homes at sites such as the Linda McCartney Centre, in Liverpool, Southport and Ormskirk Hospital, Countess of Chester Hospital, Halton Hospital and Warrington Hospital.

The Centre has a community pharmacy on site, which has recently opened as a wholly owned subsidiary of the Trust and aims to provide patients with efficient expert oncology pharmacy advice.

The best thing about being a chief pharmacist is leading a motivated team and being able to make a real difference to patients. Medicines are used across the Trust, not just within the chemotherapy area and it is important to manage medicines used for all of our patients, including those receiving radiotherapy treatments.

Medicines used to treat cancer patients are always changing and it is very rewarding being able to introduce new services to patients which see real benefits. Our counselling services for patients helps them to understand their medicines and our self-administration schemes for in-patients mean that they have a greater degree of independence and control over their medicines.

CCC was pioneering in introducing dose banded chemotherapy and maintaining the cold chain which has allowed the Trust to reduce waste to a minimum and to allow near zero waiting times for patients.

• What is your advice on being a good pharmacist and running a good pharmacy?

My best advice would be to have the patients’ best interests at the heart of everything you do. Safety is paramount, especially when dealing with high risk medicines such as chemotherapy. Being a good pharmacist involves not just being up-to-date with the latest clinical developments, but being able to work together as a team with other health care professionals, which is one of the great things about being based at The Clatterbridge Cancer Centre.

In terms of running a company, you need to be able to effectively monitor performance. Patients are best placed to help monitor this performance and their feedback helps shape service development of the future. I am in a very privileged position of being able to oversee a hospital pharmacy and also a community pharmacy. I can see the benefits of joint working and how each sector can learn from the other and work together to provide better patient care.

• Describe a typical day at your pharmacy/health centre.

No day is ever the same for the pharmacy team at The Clatterbridge Cancer Centre, but the day will start with routine checks of our manufacturing facility and ensuring that our nursing staff have all the chemotherapy they need for patients that day. We prepare the vast majority of chemotherapy 48 hours in advance and will get to work preparing chemotherapy as early in the day as possible. Each chemotherapy prescription is checked by a pharmacist before it even enters the production process and is individually tailored according to the individual patient requirements. Dedicated pharmacy technicians and assistants at The Clatterbridge Cancer Centre who have been trained in handling chemotherapy drugs will use isolator technology to prepare the various injections, infusions and tablets required by each patient. All the doses that make up each individual prescription are checked again by a pharmacist before being packaged up and stored at the right temperature in readiness for collection or delivery.

Meanwhile, on the wards, the pharmacists and technicians are quickly and efficiently assessing the immediate needs and the long term needs of all in-patients. This would include ordering supplies and ensuring previously ordered medicine has arrived at the right ward to the right patient. Patients are assessed at the bedside for self-medication and also a current drug history for each individual patient is provided in written format that is accessible by all the multi-disciplinary team on that ward during any working day. Patients are also identified for discharge and the ward pharmacy team will provide both a clinical and visual check of the patient’s current medication requirements and ensure sufficient supplies are available for them on discharge from the ward. Patients being admitted for long infusions of chemotherapy will be reviewed for any problems from their last cycle of treatment and have their current treatment clinically checked before it can be prepared.

The dedicated research and development team at the Centre ensures that patients have access to the clinical trial medication in a timely fashion and provide expert advice on oncology pharmaceutical issues prior to the commencement of trials. This involves a pharmacist reviewing trial protocols, advising on the feasibility of conducting the studies; taking into account facilities, available capacity and the skills required to dispense the Investigational Medicinal Products (IMPs).

Throughout the day, the pharmacists and technicians are on hand to answers any queries from other healthcare professionals and patients, providing all sorts of advice such as possible dose adjustments or expected side effects.

• What part of the business is most challenging to work in?

There is no single area which is more challenging than another. The challenge is to always continue to improve services for patients.

It’s difficult to think of many negative aspects of my role to be honest, but I would say that the NHS restructure and the economic climate have introduced a great deal of challenges when it comes to continuing to improve services, as cost savings have to be made at the same time. Looking at this from a different perspective though, I believe that the challenge has been used in a positive way and has encouraged innovation.

• What kind of role can community pharmacists play in cancer care?

The real clue is in the name "community pharmacists" as opposed to "retail pharmacists". Community pharmacists are in a privileged position of being able to care for individual patients, families, carers and the local communities and being able to individualise medicine usage and tailor services to improve access to and outcomes from treatments.

Aside from dispensing and supplying medicines and managing minor ailments, the community pharmacy team can support cancer care by developing services to provide specialist cancer care. Some of these services are already provided, including home care and home delivery, healthy living advice, early detection of cancers (e.g. bowel cancer screening, skin cancer awareness), smoking cessation, vaccination, travel advice (sun protection) and community health education programs. Supporting cancer survivorship is increasingly important with advances in the management and treatment of cancers. Some cancers can now be considered a long term condition and in the future one in three of us will be affected by cancer at some point in our lives.

The Community Pharmacy Call to Action is an opportunity for community pharmacists to shape the future of local services and help develop future health strategies that harness the many strengths and opportunities available to pharmacy. Community pharmacy services for cancer need to be recognised within this too.

• If you were to give up pharmacy tomorrow, what would you do?

If I were to give up pharmacy tomorrow I would probably retrain as a life coach. I have always been fascinated with what makes people tick and how they are motivated. I would like to help people to overcome some of their fears and doubts and help them get the most out of life.

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