Swydd-ddisgrifiad a phrif gyfrifoldebau manwl

The post holder will:

- Improve medicines optimisation within the hospital setting for patients admitted to the Frailty Assessment Unit.

- Work in partnership with all appropriate hospital staff, external agencies and staff including care home staff, Community pharmacists, GP Practice/PCN Clinical Pharmacists and ICB Pharmacists.

- Ensure that patients on the Frailty Assessment Unit have a comprehensive medication review.

- Ensure that prescribing is evidence-based and cost effective. 

- Provide education and training where necessary.

- Support the implementation and development of pathways and guidelines relating to medicines use within frailty.

- Work closely with Gloucestershire MOCH pharmacists and technicians in order to maximise effective system wide working across the Gloucestershire ICS.

Provision of Clinical Pharmacy Service to clinical area of responsibility.

Obtain key pharmaceutical information on newly admitted frail patients.

Information collected on a daily basis including:

Collecting, interpreting and documenting details of medication taken at home (the medication history).

Confirming details of the medication history with the patient, carer(s), GP Receptionist, the GP (occasionally), and by reviewing the patient’s own drugs from home if available, working alongside the Medicines Management Pharmacy Technicians.

Confirming and documenting important factors affecting the patient’s ability to manage their medicines at home (e.g. sight, hearing, manual dexterity, and use of a compliance aid).

Resolving any discrepancies and problems identified as a prescriber, to complete medicines reconciliation.

Provide clinical pharmacy service within Frailty Assessment Unit, ED and in reach to wards.

During the visit the pharmacist will:

Review prescriptions to ensure they are legal, safe, cost-effective, clinically necessary and appropriate, accurate, and complete.

Undertake Medicines Optimisation

Arrange for drugs to be supplied to patients, ward(s) or department(s).

Provide information and advice to nursing staff on a daily basis, about drugs, doses, administration and potential side-effects.

Provide information and advice to junior medical staff on a daily basis, and to Consultants as and when needed, including suggestions for initiating and modifying treatment.

Educate patients as appropriate about changes to their medication, and how to take specific medicines (e.g. warfarin, inhaler devices).

Access and interpret clinical information for specific patients (e.g. e-PMA system (Sunrise Clinical Manager), Patient Administration system (TrakCare), Pharmacy computer system (EMIS) as well as case notes and Summary Care Record (SCR)), and use it to individualise and monitor treatment.

Document relevant clinical and pharmaceutical information during in-patient stay which may be used to prepare discharge prescription and/or communicated to patient, carer(s) or GP.

Review discharge prescriptions written by medical staff, using professional judgement to make a final decision about content and appropriateness of discharge prescriptions when a suitable prescriber cannot be contacted.

Participate in Consultant ward rounds as appropriate, providing pharmaceutical advice and information to medical staff, nursing staff, and patients as part of a multi-professional team.

Undertake risk management and ensure compliance with legislation and relevant national policies and guidelines, along with local policies and procedures including the Trust Formulary.

Work in an effective team with technicians involved in Trust Medicines Management scheme on designated wards.

Usually work unsupervised, although the post-holder can seek advice from a range of colleagues as and when required.

Prepare frail patients for discharge from hospital

Daily tasks include:

Communicate with junior medical staff (and occasionally Consultants) to clarify aspects of the prescription including drug, dosage, frequency, duration of treatment, and length of supply when necessary.

Use professional judgement to make a final decision about content and appropriateness of discharge prescriptions when a suitable prescriber cannot be contacted.

Communicating with patients, carers, community pharmacists as necessary to establish what medication is available at home, and/or to explain changes made to their prescription during hospital admission.

Able to assess and respond appropriately to individual patient’s needs for help with managing their medicines at home.

Assessing the suitability of patient’s own drugs for re-use/continued use at home, if necessary.

Supply pharmaceutical and clinical information to the patient’s GP including details of and reasons for medication changes, advice given to the patient, or monitoring needed by the GP.

Provide highly specialised advice on appropriate drug treatment in line with own professional judgement, experience, evidence-based medicines and treatment guidelines

- on occasion, give a specialist opinion in areas where information is lacking and/or medical opinion differs

- educate junior doctors on good prescribing practice

- persuade senior/junior medical staff to follow agreed prescribing policies

 
To initiate, collaborate in, analyse and report on multi-disciplinary audits and research involving the pharmacy service and/or medical directorate as required.

Clinical Governance

Support the Divisional Clinical Governance agenda by advising on strategy for reducing medication errors and improving safety in conjunction with the Associate Pharmacy Director

- To investigate individual adverse incidents related to drug use within the Division in collaboration with the Clinical Risk and Effectiveness Department.

- To monitor trends associated with errors in prescribing, dispensing or administering drugs

- To educate other healthcare staff in the safe use of drugs

- To audit identified high risk areas

- To monitor Patient Safety Incident forms (Datix) completed by pharmacists working on the wards

Prescribing

If post holder holds a Certificate in Professional Studies/Postgraduate Certificate in Non-Medical Prescribing they must practise within the boundaries of local strategy, professional guidance and the law.

Prescribe medicines for agreed patients within their competency as a dependent (e.g. supplementary) prescriber in line with current legislation, local policies and within their own level of experience and competence

Prescribe medicines in their competency as an independent prescriber in line with current legislation, local policies and within their own level of experience and competence

Additional Contact Details

David Richards

Clinical Pharmacist Lead for Medicine 

[email protected]

0300 422 6841