Along with many other pharmacists, I found my university education always diverted my focus towards the question: how does a drug treat the disease?
It was not until my preregistration year that I realised I often described patients by their disease state or drug history, rather than using their name, when discussing cases with my colleagues. As I have progressed in my career, it has become obvious to me that, beyond the guidelines, differential diagnosis and pharmaceutical interventions, the focus should be on the patient as a human being.
Among the four guiding principles of medicines optimisation set out by the Royal Pharmaceutical Society in 2013, it is clear that we must understand patients’ experiences to empower them to get the most out of their medicines.
However, a review by the Care Quality Commission published in 2016 revealed that just 57% of patients said they felt involved in decisions about their own care and treatment.
Throughout my career as a rotational pharmacist within various specialist teams, I have found that pharmacists get limited time to complete clinical duties, such as screening drug charts, medicines reconciliation, discharge medication preparation and stock management. I always felt disappointed that I did not have enough time to dedicate to patients and this feeling became part of my ‘normal’ practice — I got used to pharmacists not speaking to the patients on a daily basis, unlike my colleagues in nursing and physiotherapy.
It was not until recently, in my current role as a clinical pharmacist, that I developed and entrenched a more patient-centric approach. When I first joined ward rounds with the multidisciplinary team — including the intensive care unit during the COVID-19 pandemic — I began to understand the difference that we can make when we fully involve patients in their care.
On the ward round, I started asking patients questions such as: ‘How are you getting on with your medications?’ and ‘Do you have any concerns?’ They would almost always respond with a request for further clarification about their treatment plan.
Recently, during discharge medication counselling, a patient who had undergone transplant surgery asked me about the indications of some medicines they had been taking for years. Most of these medicines had been started by their GP, but the patient was not counselled upon first initiation. The patient appreciated my advice and said they wished they had known the information when they started taking the medicines.
Going forward, I will encourage my patients to raise queries regarding their drug history as part of the discharge medication counselling.
This is important because up to 50% of patients discharged from medical wards have an unplanned readmission to hospital within one year. The results of one meta-analysis published in 2017 also showed that pharmacist consultation on discharge led to a 19% reduction in readmissions, compared with usual care.
My trust has implemented discharge medication service guidance that ensures collaboration between pharmacy professionals and their teams across hospitals, primary care networks and community pharmacies. This can help deliver optimal outcomes for patients on discharge and provide continuity of care. Any changes made to medication during admission can be followed up and supported by community pharmacists upon referral.
Continuing to practise patient-centred care is challenging, with ongoing pressures of staff shortages and non-clinical deadlines; however, it is important to ensure patients take their prescribed medicines in line with the recommended advice.
For instance, my trust is currently undergoing an organisational change to introduce a seven-day patient-facing clinical service, with the aim of standardising the delivery of medicines optimisation throughout the weekend. A future seven-day pharmacy service is likely to bring us closer to making medicines optimisation part of routine practice.
I encourage others to focus on the patient as an individual, in addition to meeting service demands. This has guided me to work in line with my trust’s values of ‘treating everyone as a valued individual’.
Going on ward rounds, I am an important part of the multidisciplinary team, adding direct value to patients at the point of care. This has motivated me to go above and beyond for patient-centred care.
Komal Vadday is a senior specialist pharmacist in hepatology at King’s College Hospital NHS Foundation Trust