An elderly patient on a complex drug regimen has developed a serious rash. A nurse prescriber needs advice on which of her medicines may be causing the problem. He gets in touch with the hospital’s medicines information team who provide a timely, comprehensive response based on the best available data.
Some pharmacists specialising in medicines information encounter this type of scenario regularly. But there are different types of information services roles available, depending on whether you want to work in industry, the community or hospital, and each attracts different types of enquiry.
For Dianne Bramley, medicines information pharmacist at Guy’s and St. Thomas’ NHS Foundation Trust, the most common queries cover drug interactions, how to give a dose, adverse effects and medicines safety in pregnancy.
However, Bramley also deals with more exceptional questions. “One that stands out is when I was asked by a vet how to give an antibiotic to a shark with an infected eye. I couldn’t give a very specific answer because veterinary medicine is out of our area of expertise so I gave information on the basic principles of the antibiotics such as spectrum of action and general pharmacokinetics, which helped the vet decide which drug to choose based on his knowledge of sharks.”
Bramley, who has an MSc in pharmacy practice and has been in her current role for the past ten years, explains that the trust provides two medicines information lines — one for hospital pharmacists, doctors, nurses and community healthcare professionals; and a second for outpatients or discharged patients. She says: “We don’t comment if a GP has prescribed something, but if it’s about medicines from here then we do.”
Community pharmacists regularly ask about prescription-only medicines that do not contain lactose, because so many people are lactose intolerant, according to information pharmacist Michael Stewart. Stewart works as part of a team of four at Numark, a buying group for independent pharmacies. The team fields about 50–80 queries a day on a wide variety of topics, including legal and ethical issues, the Drug Tariff and training needs. “We also get asked about crushing tablets and which tablets can go into compliance aids,” he adds.
Benefits of the job
For Bramley, solving more unusual queries is a highlight of the role. She says: “I like finding an answer to an unusual or difficult question, so when you crack it, it resolves the problem. Not only does the patient benefit, but then we can share the information. We record all enquiries on a database and can search that and see if the answer is appropriate.”
It can be challenging to promote the service to patients, Bramley says, but she emphasises that it is important to get the message across. “I’ve done some research on patient care and outcome and it proves that what we do does have an impact, so the more you know the better.”
Stewart finds it rewarding to respond to members. “You build up a relationship with regulars and know that you are helping fellow professionals to support their patients,” he says.
Minesh Unadkat has slightly different responsibilities in his role as a medical information specialist at Roche. “My job is to provide high-quality written responses to medical information enquiries from healthcare professionals and members of the public in accordance with the Association of the British Pharmaceutical Industry Code of Practice,” he says.
“I conduct literature searches and source published references to answer enquiries, referring any adverse events/product complaints to the relevant departments, and informing stakeholders of updates to our products’ summaries of product characteristics.”
Getting into medicines information
Unadkat says that, although anyone with a life sciences degree would be suitable for the role, being a pharmacist is an advantage because the pharmacy degree and routine pharmacy practice provide useful experience. He adds: “If anyone wants a rewarding, challenging, interesting and diverse job then this role is for them. However, this is not a solitary role as there are many opportunities to interact with other functions within the organisation, and we are the external face of the business.”
Stewart entered his role from a training background. “I worked for Buttercups [a training centre for pharmacists] for a number of years. Numark launched their professional indemnity insurance and needed an information department about three years ago and I’ve been here since the beginning,” he says.
Pharmacists can get involved with medicines information at all stages of their career, Bramley explains. “Pre-registration trainee pharmacists at the hospital do a rotation through the medicines information department for six weeks, and our junior pharmacists also do rotations through our department,” she says. “We offer six-month placements for the next grade up so there are progressions through medicines information if they want to go that way, right up to becoming a manager.
“University students these days do a research project for their MPharm and we offer one or two projects so they can get an idea of what it’s like to work in the department.”
Traits and skills
For those interested in medicines information roles, Bramley advises: “You need good communications skills, with patient-friendly language, but also be able to talk to consultants looking for expert opinion, tailoring your advice to the level of understanding and information of the questioner.”
Like Bramley, Unadkat highlights the importance of good communication skills and the ability to multitask. He also recommends having a basic understanding of literature searching. “However, these are all skills that can be learnt, so information services can be open to a wide range of people with different levels of experience,” he adds. “There are many potential avenues that one could explore as a result of working in information services, including working in pharmacovigilance, regulatory affairs or medical affairs.”
Stewart also emphasises that any pharmacy professional could take on a role in information services, but says it requires a slightly different way of thinking. He explains: “You’ve got to be analytical and look at all possible alternatives so you can advise on each. For example, we have to advise questioners on what they’re allowed to do, what they’re definitely not allowed to do, and what they could do ethically and legally, so they can make the decision themselves.
“You need to make evidence-based decisions and be able to support them, as you’re advising another professional who is going to base their actions on what you say, so there’s an extra layer of responsibility there. And of course you don’t have the patient in front of you and often don’t have the full story so you need to use effective questioning to get to the bottom of each query.”
The United Kingdom Medicines Information network
The United Kingdom Medicines Information network (UKMi) brings together the drug information services based in pharmacy departments within NHS organisations.
UKMi is a virtual network in which local patient-focused services in NHS trusts are advanced, developed, and supported regionally and nationally. There are around 220 local medicines information centres facilitated by 16 larger ones serving specific geographies.
Through UKMi, pharmacists and pharmacy technicians have access to various training resources and short courses, an active discussion forum, and regional and national development and networking events. For more information, visit http://www.ukmi.nhs.uk/