From adviser to prescriber: pharmacy’s evolution within the cardiology healthcare team

When our pharmacy team at Swansea’s Morriston Hospital, South Wales, first proposed embedding a prescribing pharmacist within the cardiology multidisciplinary team (MDT), it was clear that this would be a major shift in how pharmacy contributes to multidisciplinary care.

The team has always valued our input and presence. But across hospitals, pharmacists are still often viewed by colleagues — and by patients — as primarily a supply service, particularly around the discharge process. At the same time, our clinical roles are expanding and the benefits of having a pharmacist embedded in the MDT are becoming clearer than ever^​1–3​. 

This creates a tension we cannot ignore. While we evolve into proactive, decision-making roles that improve outcomes and efficiency, we cannot step away from our core services. Otherwise, we risk simply shifting inefficiencies elsewhere — a perfectly optimised discharge might be prescribed, for example, but delayed because no one is available to perform the final clinical check. It’s a balancing act. 

As ward pharmacists, we have traditionally operated at arm’s length — reactive to prescribers’ choices rather than part of the decision-making itself. But now, we are now often the best-placed clinicians to make medicines decisions alongside the diagnosing consultant. 

Why we started

Our motivation to embed a pharmacist into the cardiology team was simple: to bring pharmacy closer to where decisions are made, reduce prescribing errors and make sure patients leave hospital on the right medicines, first time.

Historically, pharmacy performance was measured by process, like turnaround times or items dispensed. Useful, but hardly a measure of clinical impact. We wanted to shift focus to outcomes that matter — preventing hospitalisation, reducing mortality and improving quality of life.

In January 2025, we placed a pharmacist prescriber directly into the cardiology MDT on a full-time basis for eight months. It sounds simple, but it represented a major cultural shift — placing pharmacy firmly within the clinical conversation rather than as an afterthought.

Getting it off the ground

Setting it up took more than enthusiasm. Stakeholder engagement was crucial. Developing a clear governance statement early on gave everyone confidence that the role was supported, accountable and safe.

There were moments of hesitation, both from ourselves — “Is this perfect yet?” — and others — “Can pharmacists really prescribe as part of the MDT?”.

Projects don’t need to be perfect before rollout. Pharmacy can be its own biggest critic — but sometimes you just need to start, measure and adapt.

Our findings

Between January and August 2025, the MDT pharmacist prescribed 8,810 medicines — 4,740 more medicines than the next highest prescriber in Swansea Bay. The top ten prescribed medicines were all linked to improved outcomes and reduced hospitalisation in cardiac patients.

Headline outcomes

• Prescribing safety: pharmacist-led discharge prescribing produced clearer, more accurate medication lists and better communication with GPs and community pharmacies;
• Deprescribing: 88 unnecessary antibiotic prescriptions and several high-risk medicines were stopped, with 567 medicines stopped in total, avoiding around 284kg of CO₂ emissions — the equivalent of 2,840 washing-machine cycles;
• Efficiency: when pharmacists didn’t prescribe, discharge delays totalled 437 hours over four months (1,311 hours annually) owing to inefficiency of communicating a prescribed discharge prescription. With pharmacist-led discharges, these delays dropped to zero with the pharmacy team instantly aware of discharges;
• Query resolution: medication queries reduced from an average of 7.5 hours to 5 minutes to resolve;
• Financial savings: antiplatelet optimisation achieved £31,742 confirmed primary-care savings, £14,467 of savings in secondary care and a projected saving of £71,875 annually.

These are tangible, patient-centred benefits that demonstrate pharmacy’s true clinical value.

The learnings

Early and continued regular engagement is essential: getting the right people on board early saves endless time later.

Governance protects innovation: clear frameworks legitimise new roles and reassure others.

Don’t chase perfection: start small, collect data, and refine as you go.

Measure what matters: pharmacy should focus on outcomes such as readmission reduction and optimisation — not just process metrics.

Developing clinical key performance indicators

Pharmacy has long fought to be part of the same clinical conversations as doctors and nurses — yet we have not always produced clinically meaningful key performance indicators with ease. Within cardiology, for example, when a patient receives a stent after a myocardial infarction or a pacemaker following complete heart block, the benefits are immediate and visible. The patient can feel the difference almost instantly.

Our work, by contrast, is often less visible — but no less vital. We have deep, evidence-based knowledge that enables us to make significant clinical decisions about medicines — decisions that directly affect safety, recovery and long-term outcomes.

In our project, we were able to evidence that impact thanks to our electronic prescribing system and the support of our digital team, who helped us extract and analyse prescribing data. This capability has been transformative in demonstrating the measurable, clinical contribution of pharmacy to patient care.

How good ideas spread

One of the most rewarding outcomes has been seeing how good ideas inspire others. The visibility and impact of the cardiology MDT pharmacist led a cardiothoracic consultant to request a similar role for their team — and, soon after, our own advanced pharmacists began exploring where they could make the biggest difference.

This reflection directly led to the creation of a prescribing pharmacist role in the vascular MDT. Each setting required a tailored approach.

In cardiothoracics, the team splits into two, so the pharmacist rotates between them and prioritises patients most in need of pharmacy input. In vascular, there is not one defined MDT but several, so the pharmacist schedules set review times aligned with multidisciplinary decision-making. In endocrinology, the pharmacist joins clinics and reviews complex inpatients as part of the MDT and supports the wider site. 

Success isn’t about copy-and-paste replication — it’s about listening, adapting and working with each team’s rhythm.

Looking ahead

We know this role works, and that the fundamentals are there for it to succeed across multiple MDTs. The question now is one of spread and scale: how we take what’s been proven in cardiology and apply it more widely, first within our health board and, hopefully, nationally.

The focus moving forward is on bridging the gap between innovation and business as usual — ensuring that, as the role evolves, any risks are mitigated, efficiencies are maximised and the quality of patient care continues to improve.

If you’re thinking of starting something similar, my advice is simple: engage early, secure governance and don’t wait for perfection.

Measure your success by how many patients leave on the right medicines, at the right dose, for the right reason — because when pharmacy sits at the MDT table, patients and the wider healthcare system benefit.