One small step for medicine, one giant leap for clinical pharmacy
As we embarked on our CwPAMS project investigating antimicrobial stewardship at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania, whilst extremely excited, we could not help but be slightly daunted by the enormity of the task in front of us. A core team was developed to plan and execute the project consisting primarily of pharmacists with support from IPC nurses and microbiologists, as outlined below, and the project wheels’ were set in motion.
Over the course of the project, it became apparent that a number of the interventions we were discussing, regarding antimicrobials, involved ward-based clinical pharmacy skills. This was met with some trepidation and was identified by some of the junior staff at KCMC as an area they would appreciate additional support with exploring.
There are well established benefits of clinical pharmacy services, including: fewer errors surrounding medicines reconciliation, improved patient safety, greater MDT collaboration, decreased length of hospital stay & greater antimicrobial stewardship. Having spent over a month at Northumbria prior to our visit to KCMC, Peter (principle pharmacist at KCMC) was keen to set up some training for his team having seen first-hand the impact a clinical service can have. Whilst unexpected, this was seen a great opportunity for the team from Northumbria to share some of their experiences with our colleagues at KCMC and help develop their service.
We began by identifying key areas which we felt encompassed clinical pharmacy:
1. Professional relationship building (adapting the NHS “#Hello, my name is…” campaign to a more appropriate Swahili version “#Jambo, jina langu ni…”)
2. Challenging decisions/prescribing
3. Counselling patients and involving patients in decisions (shared decision making)
4. Clinical validation and useful, supporting resources.
We hosted a workshop for the majority of the pharmacists, intern pharmacists and some technicians focusing on these key areas. We were conscious not to delve into specific clinical detail but to keep our focus on the general principles of working at a ward level.
We proceeded from the workshop to split into small groups of 3-4 people and conduct supported visits to various wards within the hospital. Here we reviewed a number of patient medical notes and put into practise patient communication skills.
There was clear passion and enthusiasm from the KCMC team to contribute to excellent patient care and following discussion with hospital management an initial service provision was agreed. A pilot was run where two intern pharmacists attended the ward round every day for a wee. Following this, it was agreed the following activities would be carried out: obtain drug histories from patients and monitor for interactions and adverse drug reactions, contribute to wider MDT working, update prescribers on availabilities and alternatives of medications, offer clinical advice on dosing e.g. in renal impairment and monitor drug compliance among patients. This has been very well received by the medical team and it is anticipated pharmacist input will continue to grow until it covers all aspects of hospital working.
I would like to say a special thanks to all the staff who worked together throughout the project who were so welcoming to the Northumbria team and had a clear passion and dedication to service development. I would particularly like to thank the following for helping drive the project forwards:
- Peter Benedict (Principle Pharmacist at KCMC)
- Dr Furaha Lyamuya (Microbiologist at KCMC)
- Scott Barrett (Lead Pharmacist for Clinical Services + CPhO (GH) Fellow – Northumbria)
- Dr Eva Muro (Senior Clinical Pharmacist and Lecturer at KCM College)
- Emily Skinner (Senior Clinical Pharmacist – Northumbria)
- Ruth Henein (Infection Prevention and Control Nurse – Northumbria)
Specialist Clinical Pharmacist, Northumbria Healthcare NHS Foundation Trust
CwPAMS Partnership Northumbria Healthcare NHS Foundation Trust – Kilimanjaro Christian Medical Centre (KCMC)