13th August 2018

Insight from Maria Medina

Time in general practice

3 Years

Location

HMP Isle of Wight (Category B Prison Service for Males)

Qualifications

Independent Prescriber (2017). University of Reading

Community Services and Clinical Pharmacy. (2012). Universidad de Valencia. Spain.

Mpharm (2007). Universidad Miguel Hernandez. Spain.

Current Role

I am currently working as a GP pharmacist for the prison service, with a fantastic multidisciplinary team in the development and implementation of medicines management initiatives and clinical medication review and optimisation for the continuous improvement of patient-centred services.

My life before becoming a pharmacist in GP Practice

From a pre-registration experience in hospital I went into research, where I had the opportunity to participate in the management of clinical trials and projects, looking at the application of personalised medicine for better diagnostics tools and better treatments based on individual genetic variations.

Thinking that I would continue my career in clinical research, the unexpected turns of life brought me into community pharmacy where I spent 5 years loving the patient facing role. Unfortunately I still felt very limited in what I could do and I started my postgraduate studies in community and clinical pharmacy with the idea of pursuing new opportunities and have more impact on patient care.

The opportunity finally arose when I joined the Prison Service, a multidisciplinary environment where my role evolved very quickly whilst closely working with prescribers to continuously improve the provision of therapeutic services.

GP Practice experience

A list of my day to day responsibilities will summarise my experience well whilst working in the GP practice within the Prison setting, which is attached to a pharmacy dispensary that I also need to attend.

  • Ensuring a safe, effective, efficient and rational use of medicines
  • Supporting the monitoring and follow up of patients receiving high-risk medicines and medicines commissioned by secondary care
  • Reconciliation of medicines following hospital discharge, reducing the number of transcription errors and ensuring continuity of care
  • Developing and running pharmacist-led clinics seeing patients with skin conditions, diabetes, asthma and COPD
  • Facilitating the prescribing of cost-effective alternative medications
  • Improving the patient experience of the services delivered by the pharmacy
  • Supporting the review of pathology results and identifying patients that would benefit from preventative treatment or different therapeutic approaches
  • Supporting the pharmacy technicians in the delivery of medicine compliance clinics
  • Supporting and delivering needs assessment reviews for the identification and planning of service improvements
  • Clinical audit and systematic review of the provision of care for the identification of deviation from standards

Key examples of personal challenges of practice pharmacy – what were they and how did you overcome them? (including skills, knowledge and training)

Challenge #1

Demonstrating the benefits of any time spent out of the dispensary was extremely hard (as  I had been primarily employed as a pharmacist for the pharmacy within the prison)

Solution
  • chairing the Medicines Management Meetings enabled me to build relationships and support for my role to develop.
  • demonstrating that pharmacist-led medicines management initiatives would dramatically improve the outcomes of the patients without affecting the functioning of the dispensary – this involved reducing meaningless tasks and developing and empowering staff to improve the skill mix of the team to streamline processes. The dispensary is now more technician lead, freeing me up to carry out the clinical work in the practice.
  • the invaluable support from the other service pharmacists and the doctors who created the opportunity for me to start changing the expectations.
  • Keeping my confidence that the job I was doing was of vital importance (it helped by seeing that my clinical interventions were meaningful, appropriate and very welcomed by the general practitioners).
Challenge #2

Time management and organisational skills against my continuously increasing workload and to finish my shift on time!

Solution

I had to find more efficient ways of working that would allow me to ensure patients were for example reviewed and monitored ‘in bulk’ rather than incidentally found during the clinical screening of their prescription. So I started to learn more about systematic reporting and clinical audit which would facilitate the identification of patients that required for example a blood test, or whose clinical review was due. This saved a lot of time in the day to day workload.

Key Messages

Keep calm and carry on demonstrating your value. No matter how many barriers you face and how discouraging it can sometimes be, you will always find a solution with perseverance and support.

Do not allow anyone to tell you different and be proud of the skills you can bring as a Pharmacist, who are without a doubt complementary (and essential) to those of nurses, doctors and other allied healthcare professionals in increasing access to an efficient healthcare system and preventative treatment, enhancing patient safety, improving the monitoring of patients or facilitating the screening whilst reducing pharmaceutical waste and unnecessary visits or admissions to hospital.

What are your current priorities / key areas of focus?

I have so many projects in mind, several others drafted or started but never finished. So I had to sit and think what I would require before I could continue.

I am therefore undertaking self-directed learning in project management and the service has also agreed to allow time for training opportunities that will allow me to appropriately change manage and more consistently implement the required adjustments.

How have you demonstrated impact and value in your practice?

  • Patients receiving high-risk drugs are more consistently reviewed
  • Diabetic patients are now more consistently reviewed and have better access to specialist services without the need for transport outside the prison
  • Reduction of the use of salbutamol and improvement of symptoms in asthma and COPD patients
  • Reduction of transcription errors after hospital discharge
  • More consistently supporting the continuation of care of patients receiving medicines commissioned by secondary care
  • Identification of the need for a better referral process for diabetic foot screening services
  • Structured diabetes education services for patients will soon start, promoting self care and better patient understanding of the condition
  • Improved communication with the Mental Health Service

What development do I need / am I undertaking at this point in my journey?

I need to focus on enhancing my skills in project and change management to prevent me from leaving plans buried under a pile of things to do.

What skills or competencies do you feel are important to have in your role as a practice pharmacist?

Apart from the obvious clinical skills and competences required for a safe provision of healthcare, I would highlight the need of skills that facilitate collaborative working relationships (influencing skills, persuasion, motivation, negotiation) that will make it possible for any designed action plan to be appropriately implemented and communicated to all the members of the team whose work may be affected by the changes.

I would also suggest enhanced clinical audit skills that will ensure a well-structured and accurate review of practice and results against agreed standards for appropriate identification of where practices should be improved.

What has been your perception of the i2i Network?

The i2i Network has been key in my development as a practice pharmacist as it has coached me to more efficiently prioritise the patients that would benefit the most from my input, producing a drastic change in how I would implement monitoring services and the design of medication review clinics.

The ABCDE methodology for implementing change has helped me to bring more ideas from my pile of papers, into delivering a meaningful clinic that could also demonstrate the outcomes achieved.

I could not be more grateful for the i2i network to deliver exactly what is required to empower the right practice pharmacist workforce.

I wish someone had told me………

I would have appreciated to have learnt the ABCDE methodology when I started 3 years ago as it would have made my journey a lot easier (less headaches and fewer unpaid hours) and would have meant by now that more patients had benefited from a wider scope of clinical reviews.

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