NHS England & NHS Improvement are building on the ‘NHS long-term plan‘, focusing on the mental health provision within mental health services. Against this context, we wanted to improve the therapeutic inpatient mental health care within our service by developing a clinical pharmacy technician (CPT) able to triage the patients requiring the highest levels of clinical input.
In 2017, Devon Partnership NHS Trust’s medicine optimisation team supported the senior pharmacy technician to undertake the Pharmacy Workforce Development South Training Programme in Clinical Prioritisation. The intention was to further develop the clinical pharmacy technician role with increased focus on clinical tasks for complex high risk mental health inpatients.
As a trust, we wanted to increase our patient-facing time and ensure that we focused on improving patient outcomes in line with national and local recommendations. This area of development had been prompted by national guidance. Lord Carter’s final report, published in February 2016, stated that pharmacists and clinical pharmacy technicians should spend more of their time — aiming for 80% — on patient-facing activities.
In September 2016, NHS England also produced a report into transformation of seven-day clinical pharmacy services, referencing the concept of clinical prioritisation, targeting clinical pharmacy services and highlighting the need to optimise the workforce and ensure an appropriate skill-mix of pharmacy professionals within local teams.
Since embarking on this role development process, we have successfully trained and employed six band 6 CPTs, demonstrating the worth and value added by this more advanced role. Currently, these CPTs are based across Devon covering 16 wards. Data collected from December 2021 have provided evidence of the positive impact of this new role, showing that a third of the interventions made over a two-day period were immediate or resulted in action taken. Some examples of these interventions include identifying missing consent to treatment documents/or incorrect consent received; identifying prescribing error and missing physical health checks for high-risk patients; providing high-risk medicine reviews, high-dose monitoring and ECG prompts; providing ‘anticholinergic effect on cognition’ (AEC) score review prompts on older people’s wards and requesting maintenance bloods (i.e. lithium levels, clozapine, TSH, T4 and folate).
All of these interventions prevented harm to the patient and required prompt identification and prioritisation. It has been important for the clinical pharmacy technician to work closely with the ward pharmacist and positive feedback has been received during the implementation phase. The professional relationship between the clinical pharmacy technician and ward pharmacist continues to evolve to ensure the best outcome for our patients by following standard operating procedures and working to the General Pharmaceutical Council standards.
Examples of the feedback received from ward pharmacists include:
- “Clinical pharmacy technician has a more robust process so I do not need to worry”;
- “Able to speak to patients about their medication and review medication charts more clinically whilst raising issues with me/pharmacist and/or the doctor”;
- “Very positive impact on the patients”;
- “Overall, I don’t think we would have managed to cover the wards without clinical pharmacy technician and has been amazing”;
- “Clinical pharmacy technician taking the lead in some new areas which is having a positive impact. I am sure (hoping) we can expand this further as part of the meds op strategy review here”.
Typical workflow of a clinical pharmacy technician
The CPT follows the processes outlined in the local guidance. Core tasks for the role are different to a medicines optimisation technician who works alongside a clinical pharmacy technician.
Before each ward visit, the clinical pharmacy technician identifies new patients on the bed stead list who have not been seen since the last clinical prioritisation visit. It is good practice to read in the clinic notes about the presentation of their mental illness and if the patient has been detained. This provides the necessary information to enable a holistic approach and helps to identify patients with high risk conditions receiving critical medicines. The clinical pharmacy technician then checks regularly for new blood results, completed ECGs and provides physical health monitoring for all inpatients by following the National Institute for Health and Care Excellence guidelines for antipsychotic and antidepressant monitoring. Drug charts are checked for any newly prescribed medication or changed doses and compliance. A patient consultation should then follow.
The clinical pharmacy technician will flag if there needs to be a review of drug charts with regular benzodiazepines, hypnotics, analgesics and non-steroidal anti-inflammatory drugs. They will also compare charts with the required legal mental health documentation and regularly check and assess whether high dose antipsychotic forms are needed.
Clinical pharmacy technicians attend multidisciplinary team meetings to find out about planned changes of medication, discharges and leave as well as potential new admissions. All findings and information are handed over to the ward pharmacist via a clinical prioritisation handover spreadsheet in order of the complexity of each patient. This helps the pharmacist to save time and to focus on patients who require the highest levels of clinical input.
As our organisation continues to invest in and develop the clinical pharmacy technician role, there are plans to further branch from inpatient to community mental health in the next phase.
This is an exciting time for the development of the pharmacy technician role with opportunities now available to become mental health specialists and undertake the postgraduate certificate in psychiatric therapeutics qualification. This provides a platform of clinical knowledge to provide the best outcomes for patients.
Jennifer Whitefoot, chief pharmacy technician; and Gabi Straw, clinical pharmacy technician, both at Devon Partnership NHS Trust