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Frontline fight: Questioning prescriptions


25 Feb 2016

What can pharmacists do to halt the alarming rise of antimicrobial resistance and why will they need to look further than their shop walls if they are to make a difference asks Rachel Mountain, reporter.

Questioning prescriptions

With GPs prescribing 74 per cent of antibiotics, according to PHE figures, how much ownership should pharmacists be taking?

Community pharmacist Babir Malik says: “Tackling AMR is is also a job for us.

“We shouldn’t be sending patients to the doctors who don’t need antibiotics.

“So if they come in with a cold or a cough or a sore throat, which is mainly viral, we need to explain they won’t work.”

In addition, the role of the community pharmacist can include questioning prescriptions although, somewhat predictably, a lack of patient information can prohibit pharmacists from being able to take the initiative.

Malik says: “Without knowing what a prescription is for, it is hard. You can ask the patient but even if you do they may not want to tell you.

“The summary care record will probably help but having full access is the dream.

“Then you would be able to see other antibiotics a patient has tried and whether they worked and understand why they have been prescribed their medication.”

Luc Besançon, general secretary and CEO of the International Pharmaceutical Federation, sums up the main step pharmacists can take as: “Ensuring the right dose, at the right time, in the right patient.

“In other words, ensuring the responsible use of medicines – a concept championed by FIP and which is a fundamental concept of antibiotic stewardship.

“Part of the job of pharmacists is not only to ensure the effective use of medicines now but also to ensure that the effectiveness of these medicines will be preserved as long as possible.”

In addition, the newly-acquired flu vaccination service offers another opportunity for pharmacists to open up a dialogue about AMR and to signpost patients to their GPs for further injections if necessary.

Thinking bigger

However, community pharmacists who want to take a leading role need to look beyond the confines of their shop floors.

Marie Philbin, whose own work on AMR in the Midland Regional Hospital in Tullamore, Ireland, saw 20 new posts created across the country for antimicrobial pharmacists, has some advice.

“Multi-disciplinary team working is key – you are not going to have success on your own.

“You may have limited success in terms of educating your patients one-to-one but really the overall success of any of the other interventions in terms of education and guideline implementation has to be multi-disciplinary.”

She recommends starting small and speaking with a single GP practice and then building on that work and engaging with additional practices after that.

“It is all about feedback and having the appropriate stakeholders on board before you make any intervention, and that’s how I started out,” she said.

“And if you don’t measure, you don’t know what you’re dealing with – data is very valuable.”

Meanwhile, Besançon offers an even wider perspective.

“Antimicrobials are used in inappropriate ways all over the world.

“Despite efforts by an individual community – or even an entire nation – being valuable, they won’t solve our problem.

“We can’t act in isolation.”


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