Training as a pharmacist prescriber costs the taxpayer money. It also requires considerable personal commitment for the pharmacist concerned, as well as support from his or her colleagues. Once obtained, what difference does this qualification make?
There is one clinical benefit that I have been able to measure for our hip and knee replacement patients. This surgery is associated with post-operative constipation, partly because almost all our anaesthesia is with local and spinal blocks. A few months after I qualified as a prescriber, I noticed that the requests for glycerol suppositories on ward rounds seemed to be fewer. I looked back at the supplies of these from stores, and the decrease coincided with my prescribing, even increasing slightly when I was off work for two weeks. Previously, laxatives were being added the day after surgery, when the ward round took place. Now I prescribe prophylactic laxatives around 24 hours earlier. This may not save any money, but it makes a difference to the patient experience. Several patients have surprised me with their gratitude when I have mentioned adding laxatives to their charts after their operation, since they remembered problems with constipation during a previous admission.
Before I became a prescriber, if there were errors or omissions on the drug chart when admitting a patient, we used to have to find a doctor or write an “intervention form” to attach to the chart, requesting amendment. Given that we admit about 100 patients a week, some of whom arrive with a separate bag for their medicines, this is quite onerous. I qualified as a prescriber in July 2008. The number of intervention forms for this centre was 796 in 2007, 560 in 2008 and 271 in 2009. Now that the other regular pharmacist here is also prescribing, the number of intervention forms is negligible (most relate to CDs). The time it takes us to sort out the drug chart as prescribers is about the same as it takes to write and attach an intervention form. Our time is unaffected, but the saving in medical staff time is obvious.
What I had not expected before I did the course was the personal satisfaction that I would experience as a prescriber. Previously, passing items on to the medical staff to sort out was like leaving a job half-done. Now when I admit a patient, I can walk away from them knowing that I have sorted out all those details and loose ends. Job done.
Christine Dixon is principal pharmacist at the South West London Elective Orthopaedic Centre, Epsom and St Helier University Hospitals NHS Trust
