“In the pharmacy department, the patient is at the centre of everything we do – and we do a lot”
Ann Mounsey is chief pharmacist at Imperial College Healthcare NHS Trust. Thursday 5 July marked 70 years of the NHS – and Ann’s 30th year at our hospitals. She reflects on how pharmacy has evolved since her first day at Charing Cross Hospital.
The most common clinical intervention for our patients is the giving of a medicine. Across all of our sites today, there will be at least 19,000 ‘administrations’ of medicines, and this doesn’t even include outpatient prescriptions and discharge medicines. All of this keeps our relatively small department (which represents only two per cent of the Trust’s entire workforce) busy. But pharmacists and pharmacy staff are a vital part of hospital care, as experts in medicines and their use.
In the pharmacy department, the patient is at the centre of everything we do – and we do a lot. We ensure that medicines are used safely, appropriately and economically; we ensure adherence to all the legislation around their use; and we cover the logistics of getting medicines prescribed and to the wards so that they get to the right patient at the right time. We also provide education and training on medicines to patients and staff and we are involved in research and clinical trials.
How pharmacy has evolved
My first day at Charing Cross was 5 July 1988 so I’ve been here for 30 years. I’ve had several different roles in pharmacy since and, in 2014, I became chief pharmacist for the whole Trust. I lead pharmacy staff and our directorate and so work across all of our hospitals.
I’ve seen pharmacy change significantly since I started. Twenty or 30 years ago, the main focus of the pharmacy department was moving stock from A to B to ensure patients got their medicines when they needed them. Back then our role also involved traditional manufacturing, making the medicines themselves, on the hospital site – in fact we used to have a large manufacturing unit at Charing Cross which closed in 2000. As a junior pharmacist, it was actually a lot of fun to make the medicines, from aspirin suppositories to cocaine mouthwash!
Nowadays pharmacy staff are out on the wards and sharing expertise with patients and other clinical staff, making sure patients are being prescribed medicines appropriately. We also have an increased presence in outpatient clinics in our role as independent prescribers – something which was unheard of when I first started. It can be really complex. A significant number of our patients are now prescribed more than 10 different medicines, so our clinical expertise is more important than ever. People are living longer and living with several conditions at the same time. Today we have 80-year-olds who have had a kidney transplant and are also living with HIV – that combination was unheard of 30 years ago. We also play a really important role in antimicrobial stewardship, which involves making sure antimicrobial medicines, including antibiotics, are used appropriately, in order to reduce microbial resistance and ensure they remain a safe and effective treatment for patients.
Since I’ve been at the Trust, the pace of healthcare in hospitals across the NHS has changed. It used to be that you would stay in hospital for much longer periods, whereas now patients are discharged home a lot quicker. This means we need to be there with the team on the ward, making sure patients receive the right medicines as efficiently as possible. It’s also really important that we’re involved in planning for patients’ discharge, so there aren’t delays to patients returning home.
We also work much more closely with patients themselves. If you educate a patient on how to take their medicines appropriately and help them understand their illness, you’re more likely to find out whether they’re going to be compliant with the medicines. We also operate a medicines helpline here: if a patient has still got questions about their prescription when they get home, or they read the product information leaflet and have concerns, they can phone the helpline for advice.
Making history in our hospitals
Part of why I began a career in pharmacy was because I am fascinated by the history of medicines. Sir Alexander Fleming discovered penicillin in 1928 at St Mary’s Hospital and was vital to its development. I look at our consultants today and I wonder who is going to be the next Alexander Fleming.
I’ve been fortunate to be involved in some really important clinical trials during my career. I remember my first Saturday on the job in 1988, I was dispensing drugs for a clinical trial at Charing Cross that turned out to be a first in human study of temozolomide, which is used to treat brain cancer. We did clinical trials on this medicine for over 12 years. I was also involved in one of the first trials of what’s now known as Infliximab and used for the treatment of a number of conditions. It was a huge development in the field of biological medicines by Professor Ravinder Maini during the 1990s at Charing Cross. When you contribute even in a small way to a major development like these, you might not get any of the glory, but you know that you have been an important part of a process that has made such a significant impact on patient care. I think that has to be all of our raison d’etre – to help our patients in whatever way we can.
We keep about 3,000 different preparations within pharmacy in one form or another but not all the medicines that we use today are ‘new’. We have a lot of historical objects at Charing Cross in the form of bottles, equipment and books. I have a copy of the 1935 Charing Cross Hospital Formulary and an even older British Pharmacopeia. You can open the books on almost any page and find a medicine which is still in use in some form, as it is still the most effective treatment for a particular condition.
When I first came to Charing Cross I was slightly shocked to find out that we were the custodians of the leeches – and still are today! They are used on some patients who have had reconstructive surgery to help repair circulation in the blood vessels. People have been using them for thousands of years. We keep them in their own fridge in the pharmacy to keep them relatively dormant, so that they don’t wriggle too much when we have to get them out for use or to clean them. It also stops them escaping!
I can’t believe working here for 30 years has gone so quickly. One of the best things about my time at the Trust has been working with the rest of the pharmacy staff - I’ve had such fun here with the team. I really enjoy my job at the Trust. While moving to the chief pharmacist position gave me a much bigger role across the Trust, my years spent on the Charing Cross site, which shaped who I am now, will always be really special. I think that the pharmacy department at the Trust is a really great place to work – there are always challenges but there’s never a dull moment.
The people in my department are great. I have a genuine interest in developing our staff and I hope that comes across in how the department runs.
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