Joan Peppard is a Chief Pharmacist at the Midland Regional
Hospital Tullamore, Co Offaly, Ireland, and serves on the EAHP Board as
Director of Professional Development and has been the head of the Hospital
Pharmacists Association of Ireland twice.
In an exclusive interview with HealthManagement, Joan Peppard shared her thoughts about the goals
of EAHP, the challenges facing pharmacists and the role they play in the
promotes the best and safest use of medicines and medical devices. At the same
time, it is often said that pharmacists use their own systems rather than use a uniform process in providing patient
care. Could you comment?
I would actually question the evidence for the assertion that hospital pharmacists like to use their own systems in preference to accepting more uniform processes. As part of the multidisciplinary team, I believe hospital pharmacists are open to and welcome evidence-based guidelines. EAHP’s perception is, at least from our member associations, that common protocols and guidelines are often welcomed and indeed requested by the profession, albeit with an obvious need to reflect and respect certain local or national realities. This perception was most recently confirmed by the enthusiastic input into and positive reception about the 44 European Statements of Hospital Pharmacy published in May 2014 (http://ejhp.bmj.com/content/21/5/256.full.pdf+html)..
However, in any guideline or protocol development there is
also a need to allow both local innovations as well as permit a sense of local
ownership. It’s a balancing act, but overall I do not recognise the suggestion
that hospital pharmacists are difficult in terms of adopting uniform systems.
Indeed, it is the opposite criticism I sometimes hear – that hospital pharmacy is
a profession with a great love for standard procedures! Indeed, to ensure the safe
use of medicines, our profession could not be anything other than orientated in
drugs move to non-prescription status and more drugs become available to consumers
through self-selection, how can pharmacists effectively monitor which drugs patients
are taking and record this? Is drug interaction a cause for concern, especially
when it comes to elderly patients?
Medicines reconciliation by pharmacists is one of the key ways in which health systems can tackle this particular issue. In an ageing society, and with an ever expanding number of new medicines to treat the growing incidence rate of chronic disease, the need for medication reconciliation services will only increase. It seems to EAHP that every European health system needs to immediately implement greater use of the hospital pharmacist expertise in this area to address the risks presented by polypharmacy, both prescribed and self-selected.
Underlying this, a statement strongly endorsed not only by
the hospital pharmacy profession, but also European patient groups and other
healthcare professionals at our 2014 Summit was “All the medicines used by patients should be entered on the patient's medical
record and reconciled by the hospital pharmacist on admission. Hospital pharmacists
should assess the appropriateness of all patients’ medicines, including herbal and
dietary supplements.”(http://ejhp.bmj.com/content/21/5/256.full ).
resistance has been in the news a lot lately, and the World Health Organization
feels that pharmacists are in the best position to promote the appropriate use of
antibiotics. Does EAHP have a position on this issue?
Yes, EAHP has a strong position on this issue set out in a recent policy statement agreed at our last General Assembly of member countries in June 2014. Antimicrobial resistance is one of the biggest health challenges that European and global governments currently face, and, alongside improving the research environment for new agents, serious policy is required in relation to improving antimicrobial stewardship. This means leveraging the full potential of the hospital pharmacy profession in relation to the conduct and management of stewardship activities in the hospital setting (http://www.eahp.eu/press-room/new-year-appeal-europe-make-2015-year-action-amr). These stewardship activities are evidence-based and translate across different health systems. EAHP also believes that we need constant policy vigilance in respect of how to improve the managed use of antimicrobials not only in human medicines, but also in other sectors such as agriculture, veterinary and aquaculture settings.
The use of electronic prescribing has been increasing in recent
years. What are the major pros and cons of it in your opinion? Does the EAHP have
any set goals in this regard?
Yes, electronic prescribing is a real area of potential gain
for health services in the years ahead, and in a recent policy statement from
our member associations EAHP has made a call for its uptake to become universal
across Europe[http://www.eahp.eu/practice-and-policy/EAHP-statements]The gains
of electronic prescribing are many, but above all, it has a major part to play
in improving patient safety through improved communication and reducing
Ideally we’d like to see such systems supported by additional
eHealth utilisations such as bedside scanning of medicines to reduce errors at the
point of administration. This requires changes to the way medicines are bar-coded,
and we are working with European pharmaceutical company associations to
investigate the possibility of making such changes in the years ahead.
The European Statements of Hospital Pharmacy, supported and
endorsed by European patient groups and other healthcare professional
associations states: “Hospital pharmacists
must be involved in the design, specification of parameters and evaluation of ICT
within the medicines processes. This will ensure that pharmacy services are integrated
within the general Information and Communication Technology (ICT) framework of the
hospital including electronic health (eHealth) and mobile health (mHealth) procedures.”(http://ejhp.bmj.com/content/21/5/256.full)
opinion, how can pharmacists contribute to the drug development process?
Pharmacists have a very important role to play in drug development
processes, including contributing to the management of clinical trials in the hospital
environment. After all, it is the hospital pharmacist who is the resident expert
on medicines in the secondary care sector.
However, to be able to conduct this role to the full it is
critical that the hospital pharmacist has access to all relevant information
for decision-making. This relates not only to the patient’s medical record, but
also to the entire information about past clinical trials. Sadly, in both
respects we are still battling to improve the national and European legal
landscape. However, it was pleasing to see so many health stakeholders endorse
our calls for pharmacist access to the patient record at the European Summit on
Hospital Pharmacy last year [Statement 4.3 “Hospital
pharmacists should have access to the patients’ health record. Their clinical interventions
should be documented in the patients’ health record and analysed to inform quality
well as to witness the progress being made by the AllTrials campaign for
improved transparency in clinical trial reporting
issues will continue to be a focus for EAHP in the year ahead.]
is focused on
multidisciplinary healthcare. As pharmacists are key members of the
multidisciplinary team, what are some of the initiatives EAHP plans to support
pharmacists and to enhance their role in improving patient care and
In the hospital, multidisciplinary experts working as a team
with the patient at the centre of the combined efforts is the ideal approach. Yes,
inter-professional barriers can become an obstacle to improvement and service delivery,
so constant attention must be paid to this factor.
From EAHP’s perspective, we are acutely aware that few of
our ambitions for the future of our profession can be achieved unless they are
aspirations that are also shared by the professions we work with. For this reason,
the new foundation of our practice development activity – the 44 European Statements
of Hospital Pharmacy - were formed and agreed not by hospital pharmacists alone,
but through a thorough and robust consensus process with representatives of European
patients as well as doctors’ and nurses’ organisations. We have stated that everything
EAHP wishes to achieve for hospital pharmacy is underpinned by the principle of
working in a multidisciplinary team. Having now formed our vision for the future
of the profession, it will be my privilege during my term as President of EAHP to
turn vision into reality. Just as it was vital to work with other professions in
forming the vision, so too I will be seeking to continue that engagement with doctors
and nurses and, of course, patient groups in respect of implementation activity.
you foresee in the future of pharmacy?
I am fortunate to work in a profession that I love, that has
continued to develop and to challenge me to excel in the interest of patient
care since I graduated. I see the onward trajectory of development for hospital
pharmacy continuing, with a greater integration of the hospital pharmacist into
the care of each individual patient in the hospital and across the care
settings. I believe that greater use of technology in even the smallest of our
hospitals is part of the future. However, the future of hospital pharmacy lies
in our graduates, with their ongoing commitment to maintaining and developing
their skills and knowledge in the interest of patient care and practised in a
spirit of collegiality with all other healthcare professions.
It is recognised that Europe has an ageing population and that polypharmacy is an issue that particularly presents in the elderly. I think the biggest challenge for individual hospital pharmacists, as part of the multidisciplinary team, will be empowering the individual elderly patient to be knowledgeable of and have an understanding of their medicines in the context of their illness and well-being. This will require additional consideration of the needs of the individual when facing the combined factors of aging and illness.
The hospital pharmacy profession is challenged with getting resources to enable the daily needs of the elderly patient to be met by the multidisciplinary team. This is certainly a challenge from ensuring the integration of patient safety considerations in new technology to managing the medication reconciliation needs in a busy hospital, to ensuring robust evidence for the use of new medicines in the elderly as well as the ever-growing problem of medicine shortages.
Evidence-based care is a priority for hospital pharmacists, and we need the inclusion of elderly patients in clinical trials in order to inform treatment choices. People are living longer, and have an expectation that treatments will produce cures and improve their quality of life. It is not acceptable to exclude the elderly patient from clinical trials of new medicines. To potentially exclude the elderly from the benefit of these new medicines or to increase the risk when these medicines are used could even be considered unethical.
The commitment of hospital pharmacists to lifelong learning and maintaining expertise is very real. Accessing a constantly expanding number of new medicines to treat the growing incidence rate of chronic disease as well of from the innate desire of hospital pharmacists to contribute effectively to patient care underpins this commitment. This same commitment will drive hospital pharmacists to further develop their expertise in addressing the needs of the elderly person in the hospital and related care settings as the need arises.