Providing evidence that impacts on patient care
Andrew Campbell, Kal Dhanda and Emily Johnson explain how the pharmacy team at an NHS mental health trust use library services to provide evidence that impacts on patient care.
DUDLEY and Walsall Mental Health (DWMH) Partnership NHS Trust employs a small pharmacy team who are located across the Dudley and Walsall boroughs. Prior to 2012, pharmacy services to the trust were provided via a service level agreement (SLA) with the neighbouring acute trusts. In 2012, the trust decided to employ an in-house pharmacy team as part of a strategy to create a more responsive and quality-driven service, centred on patient care. Patient-facing services are provided by a locality pharmacist and medicines management technician. The team is often faced with enquiries from both healthcare professionals and service users, and these enquiries often require a timely, evidence-based response to reinforce medicines optimisation. With an increasing demand to provide accurate and contextualised information, the pharmacy team engages with library services to support the growing demand for quality information at the point-of-need.
Health Education England and CILIP’s A Million Decisions campaign has identified the need for an evidenced-based approach to healthcare provision.1 It aims to make the best use of library services, to impact on evidence-based decision-making across the NHS in England.
Across the NHS, libraries offer a range of services to assist healthcare professionals in obtaining evidenced-based information. This in turn has clear implications for the delivery of patient-centred care. The trust provides a range of integrated mental health services for people across the communities of Dudley and Walsall. The trust has its own library, which provides a tailor-made service to staff, meeting their informational needs. The range of services offered by the library include: literature searching, inter-library loans and training on how to access electronic resources and databases.
At the trust, the pharmacy team are pro-active users of the library service. Library usage is encouraged to optimise the use of available resources and to maximise their patient facing activity which is in line with the Lord Carter review. 2
This article identifies some of the ways in which a responsive library service can support a small clinical team, in this case the trust pharmacy team, to optimise decision making and promote cost effective prescribing.
Why use the library service?
Library staff are trained to identify and critically appraise reliable information sources, which are designed to enhance the quality of the information obtained. The services offered by the trust library are flexible, responsive and contextualised. The library service underpins medicines optimisation by promoting evidence-based options and facilitating shared decision making. By conducting searching on the pharmacy team’s behalf, the library service enables this staff group to work more efficiently which leads to a more patient-centred approach.
The library services have responded to the needs of the pharmacy team which is reflected by the resources which have been made available to support them in practice. The library also provides access to a range of resources which are available via tablets and smartphones supporting the pharmacy team to make informed decisions in real time.
Impact on patient care
The use of the library staff’s expertise and resources has facilitated a more timely and evidence-based approach to the patient facing pharmacy staff. This has strengthened the confidence of the pharmacy team in their interactions with healthcare professionals and service users alike. This close working relationship between departments has mutually benefited both teams; the library staff have grown in confidence in their dealings with the pharmacy team and have a clearer understanding of their informational needs.
The pharmacy team increasingly recognise the value of the library services in supporting them to undertake their advisory role to both healthcare professionals and service users alike.
Below are three case studies which highlight the collaborative working between pharmacy and library services:
* Smoking cessation – the library service has been instrumental in the pharmacy team’s review of the literature on nicotine replacement therapy (NRT). This review included the prescribing of both physical healthcare medicines and psychotropic medicines and their safety in combination with NRT. The review also included the impact of smoking on drug treatment and the associated recommended monitoring that should be undertaken to support patient safety. This literature search supports the implementation of the trust’s smoke-free strategy.
* Depot Injections – in response to a patient request for administration of a long-acting antipsychotic depot injection in the deltoid muscle as opposed to gluteal muscle. Library services undertook a literature search which supported patient-led decision-making and detailed the available evidence in support of the proposed route of administration.
* Clozapine-induced constipation – as part of a pharmacy project, library services were asked to undertake a literature search to identify the most effective treatment for clozapine-induced constipation. A review of the identified literature enabled the pharmacy team to outline recommendations for evidence-based treatment. This knowledge has been shared with patient-facing staff and as a consequence, there has been heightened awareness of this potentially life threatening side effect amongst healthcare professionals and engagement with service users has reflected this.
Potential future working
Following on from the successful collaboration between pharmacy and library services, both teams have identified potential areas of future working:
* Contextualised information – as a result of our collaborative working, there is an identified need for the contextualisation of information by library services. This might involve some degree of summarising key research findings.
* Policy review – the pharmacy team could be supported by library services in a programme of actively providing evidence to support developments to new or existing policy.
* Optimal models of pharmaceutical care – at present the trust pharmacy team deliver services along a traditional model. With a greater focus on the NHS to improve efficiency, the library service could support the pharmacy team in exploring new ways of working – for example, how best to integrate pharmacy staff in a home treatment setting.
Promoting informed decision making
At DWMH, the pharmacy team has developed a strong working relationship with library services, which has resulted in a more efficient way of working for the pharmacy team. This has led to improved responsiveness to the needs of service users and staff. In light of the recent ‘A Million Decisions’ campaign, which is focused on integrating the skill mix of library services with the delivery of evidence-based practice, there is a clear drive to promote informed decision-making. The pharmacy team will continue to work collaboratively with library services to promote optimal patient care in fulfilment of the ‘A Million Decisions’ vision.
1 CILIP, 2017. A million decisions.
2 NHS England, 2016. Transformation of seven day clinical pharmacy services in acute hospitals.