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15 January 2021
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Pharmacy rising to the challenge

By Mr Andrew Mikhail

Past Chief Pharmaceutical Officer's Clinical Fellow

I remember it was the end of March. I had been working from home for about two weeks before I was contacted to join the pharmacy senior team at my previous hospital to support the frontline response to the Covid-19 pandemic. I was riding my bicycle through Mile End road heading towards Whitechapel for my first day back at the same hospital where I worked prior to starting the Chief Pharmaceutical Officer’s Clinical Fellow Scheme at the General Pharmaceutical Council. This ride was different from any previous -  the road used to be buzzing with life. The eerie quietness and worried faces of the few people walking in the streets did not leave a positive impression on me.

During my fellowship I had been spending time working under and learning from healthcare leaders within the health economy. I invested in refining my leadership style, drawing upon several leadership theories, principals and frameworks. Going back to the frontline I recall the countless thoughts going through my head: What it will be like? Will I be able to lead and deliver in such environment?

I have been working in acute hospitals for the past seven years and I know exactly how stretched we get during winter. The sight of patients waiting in corridors is a reoccurring scene. Responding to the pandemic from a strategic and policy level as a clinical fellow I was aware about how the situation was getting out of hand in neighbouring countries and of the UK efforts to resolve drug shortages, expand ITU capacity, increase PPE availability, and so on. In such a VUCA world it is no surprise how complex and chaotic the situation may be! The only certainty was that my observing days were over, and I would need all the knowledge, skills and experience that I had gained to deliver on the task in hand.

I led and supported three work streams at my local Trust: pharmacy workforce, wellbeing and operational levels, commissioning of pharmacy services for the new ITU unit, and managing drug shortages. Through this article I will focus on how different the collaboration between pharmacy, medical, nursing and senior management teams was and how pharmacy being one of the key driving forces enabled us to successfully navigate these tough times.

From personal experience, at an acute trust level, pharmacy might get invited late on, or indeed be forgotten, when a change of course is imminent. This time it was not the case. This excellent collaboration was the fruit of multiple factors, underpinned by the fact that our pharmacy teams showed their worth and did not disappoint.

There were several critical drug shortages, for which our pharmacy teams worked in harmony within our trust and outwardly with other providers, commissioners and regional NHS teams to mitigate. We produced plans and forecasts to ensure the use of these drugs was rationed and that our stock control was watertight. We used our aseptic and manufacturing capabilities to produce readymade preparations to minimise risks to patients and release our nurses to look after the very sick. We primed our communications to reach out to doctors and nurses of all grades and disciplines to make sure that any changes to routine practices, in terms of medicines, were clinically and operationally validated to deliver the best outcomes to our patients.

Our pharmacy workforce proved versatile with their armoury of clinical knowledge, allowing them, with minimal training, to be swiftly redeployed across different specialties. We continued with patient safety nets, particularly when medicines were used outside routine practices, to treat the novel virus and to support doctors and nurses who were working outside their specialties.

In some instances, our ability to pay attention to tiny details and our procedural approach were perceived as ‘resistance to change’ within our profession. When I was working as a speciality lead pharmacist dealing with the introductions of new medicines, clinical guidelines or PGDs I was mindful that I should maintain a fine balance between a conscientious style without compromising patient safety. However, this very approach proved a great asset when we produced a highly commended project plan for the expansion of our ITU unit to work at more than its quadruple capacity.

The plan included a pharmacy being set-up on the newly commissioned floors to help our nurses to access medicines quickly and easily without jeopardising the infection control measures and safe storage of medicines. We organised backups, even for our contingency plans, to ensure that our workforce was always able to maintain operational services.

As a profession I do not think we need to acquire new skills or significantly expand our knowledge beyond our routine continuous professional development. What we do need is to collaborate better and proactively promote our presence. In a strange way, we must acknowledge the impact the pandemic has had in providing the opportunity to show that pharmacy professionals can provide great clinical leadership and are a vital cog in maintaining a sustainable, proactive, and safe health system.

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