A timeline of discussions with the HSE regarding the development of a  fit for purpose career structure recognising the value and expertise that Hospital pharmacists bring to  modern healthcare has been published under the CAREER STRUCTURE tab.

The length of the negotiations coupled with failed implementation despite clear safety, quality and financial benefits is of great regret to members of the profession who have worked tirelessly and diligently to improve services, expand roles and bring expertise in the use of medicines from the pharmacy to the side of the patient.

The resource on the website speaks to the lengths that the profession has gone to in order to drive change that benefits patients, local hospitals, the health care system and the government. 

 

Dear EAHP Member Presidents and Delegates,

We thank you for your continued support of the EAHP Congress, which we highly appreciate. In this extremely challenging time of the COVID-19 outbreak and, as of yesterday, March 11, pandemic, EAHP has been closely monitoring the problem and has been in constant communication with the Swedish authorities regarding the COVID-19 situation. After much consideration, we are extremely sad to announce the postponement of EAHP’s 25^thAnniversary Congress, which was scheduled to take place in Gothenburg, Sweden from 25-27 March 2020. 

We are sure that like EAHP, sponsors and participants will be disappointed as this was planned to be a celebratory event.

EAHP will now seek to reschedule the event for a later date, precise timing and venue still to be determined based on the COVID-19 pandemic development and on venue availability.

EAHP’s primary concern is the safety of both participants, sponsors, committees and all of those who had planned to attend the Congress along with the investment that all have made to be present.

There has been so much uncertainty regarding the COVID-19 outbreak and the situation has been changing daily regarding the travel restrictions imposed by national authorities, hospitals and sponsor companies. A lot of our colleagues have been already cancelling their participations due to restrictions applicable in their home countries.

The final decision was made today based on the announcement made yesterday by the Swedish Government to ban gatherings of over 500 people and quickly growing risk for all possible participants. Conferences and congresses are explicitly mentioned as some examples of banned gatherings and those who violate the ban may be fined or imprisoned. This is a unique decision and no Swedish government has ever made use of this opportunity before.

The Covid-19 pandemic is a force majeure situation, which is outside of our control and certainly could not have been foreseen when preparing the congress over the last 2 years. This extreme situation and the Swedish government’s decision leaves EAHP with no other choice than to suspend the organization of the congress until new circumstances allow EAHP to organize the congress.

We are very thankful for the support that has already been shown to us by sponsors and participants alike given that EAHP’s annual Congress is the highlight of the year for many. 

Committed to providing professional education

EAHP, like all of you, will feel the impact of this decision and we want you to know that we’re fully committed to providing the educational content you have all come to know and value. The success of the Congress is the key element in providing other educational programs, grants and projects which many of you may be aware of.

 
We will keep you posted as soon as we have more information and we thank everyone in advance for your understanding and wish you, your families, colleagues, patients and companies the best during this critical time.

Kind regards on behalf of the Board and EAHP Team.

____________________________

Jennie De Greef 

Chief Operating Officer

European Association of Hospital Pharmacists (EAHP)

Boulevard Brand Whitlock 87 Box 11 (4^th floor)

1200 Brussels

Tel:  +3226692510 

e-mail: jennie.degreef@eahp.eu

www.eahp.eu

EU Transparency Register ID Number: 82950919755-02

High performing organisations see the benefit in training their workforce. This is true in many sectors. It makes sense for members of staff to be up to date and skilled in their areas of expertise. This is especially relevant for professionals who need to use their specialist knowledge to expand and build on their skills to stay up to date and build their expertise.

There is a reward for this investment - better, higher quality services delivered by people who are actively engaged in their own careers and development. 

In healthcare the reasons for investment are strong - if you look back 10 years the technology and medicines that we have to chose from have changed considerably. Our relationship with patients, prescribers and the health service as a whole has become more complex.  

The HSE recognises that key staff require education and provides study allowances to medical staff detailed below. 

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https://www.hse.ie/eng/staff/leadership-education-development/met/ed/fin/

Educational Supports

Financial Supports

There are currently three schemes in operation which provide financial support to NCHDs and consultants funded by the NDTP.  The schemes are:

Training Support Scheme (TSS)

Additional Training Support Funding has been made available to NCHDs from July 2019 onwards. This scheme is in addition to existing financial supports such as the Clinical Course and Exam Refund Scheme and the Higher Specialist Training Fund. Funding is allocated based on Grade and the table below indicates the amount available under the TSS for each registration training year, July – July. Funding is available pro-rata for doctors employed on shorter contract durations.

Grade	Amount per Registration Year
Intern	€750
SHOs and Registrars	€1250
SPRs/GP Registrars/Psychiatry SRs on a training scheme	€2000

A list of approved clinical courses, conferences and examinations that can be claimed for under the TSS are listed here

Further information on how to submit claims for refunds under this Scheme will be communicated to NCHDs over the coming weeks. An Information Sheet / User Guide will also be made available on this page. In the meantime, please see link to flyer which contains additional details regarding the Training Supports Funding Scheme

1. Clinical Course & Examination Refund Scheme for NCHDs

This scheme is open to all NCHDs.  There is an approved list of clinical courses & examinations qualifying for this refund scheme contained in the guidance document. A maximum contribution of €450 is payable to NCHDs for each course or exam on this list. An application form must be completed to apply for this refund.

2. Specialist Training Fund for Higher Specialist Trainees

This scheme is open to higher specialist trainees and 3rd/4th year GP trainees only.  The funding available to each trainee is €500 per year of training and the fund rolls over if not claimed in a particular year. 

The Specialist Training Fund for Higher Specialist Trainees (2017) guidance document contains a detailed explanation of the Scheme should be completed and submitted to the your Postgraduate Medical Training Body to claim your refund.

3. Consultant CME

This Scheme is open to Consultants employed in the public service. It allows Consultants claim a maximum of €3,000 pa towards courses and conference, reference materials and professional fees. Further information is available in the memo claiming travel costs the guidance document and the application form should be completed in full and returned to the relevant employer for processing.

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Within Hospital Pharmacy there is no formal agreement over the need for or provision of individual training budgets. As you can see it is quite feasible that hospital; pharmacists could be working as part of a multidisciplinary team where their up to date specialist knowledge is relied upon in order to get the best patient outcomes, however unlike their medical practitioner colleagues they are not in an equal position of having the support in terms of time or funding .

Hospital Pharmacists are motivated and keen to both keep up to date and upskill. The health system that we work in relies up on this but does not automatically provide support for it. 

It is not uncommon for Hospital Pharmacists throughout their careers to self or part fund education that does not directly financially benefit themselves, but increases their effectiveness and their value as an asset to the health service. 

As we are now looked upon as specialists in the area of medicines use should we expect parity on funding for education? Should our employers recognise that Hospital Pharmacists are an asset that require support and development to get their maximum potential?

Head over to the forum to discuss...

 

The HPAI President Fionnuala Kennedy has been interviewed as part of their "In conversation with..." series.

Take a look on the link here for an interesting piece covering a wide range of topics including FMD, Brexit , the roles of hospital pharmacists and opportunities that exist . 

Pharmacist Staffing Ratios – An Opinion

Irish Hospital pharmacists operate under a job description from the 1970s.  The 2011 McLoughlin Report (Hospital Pharmacy Review) identified specialisation as an area for implementation for the Irish Hospital System.

In 2016 HIQA began its first real foray into Irish Hospital Pharmacy with its medication monitoring inspections.  HIQA are now entering a second phase of Medication Monitoring Inspections.  In 2019, with specialisation still unimplemented,  this article will review is it also time to look at staffing levels for Irish Hospital Pharmacy Services to help support implementation of  recommendations from past and future HIQA reviews?

Typically hospital managers have looked at the effectiveness of hospital pharmacy services on basis of budget; drug spend.   With the increasing acuity of hospitalised patients receiving complex medication regimens, the national focus on medication safety and the increasing number of drug safety warnings from the FDA, EMEA and HPRA, the focus on hospital pharmacy effectiveness needs to move away from drug spend only.  The Society of Critical Care Medicine has recognised the pharmacist as an essential member of the intensive care team.3  The American Academy of Paediatrics policy statement on prevention of medication errors in inpatients specifies the need for adequate pharmacy staffing ,and the Joint Commission has stated that effective staffing is a critical component in the provision of safe, high quality care.3  Meanwhile in Ireland, there is no body that regulates pharmacy or that has made staffing recommendations.  Instead recommendations are made for services without recognition of the ability of a department to provide such services.

There are limited studies available in Ireland, but some suggest that clinical pharmacist services also positively contribute towards the overall hospital budget.^,

Are patient ratios really that important?

Evidence exists to show that pharmacists with excessive patient load adopt a belt and braces approach to medication reviews.  Pharmacists in these circumstances focus on; recommended drug dosages by enquiry rather than being medication experts who provide a comprehensive assessment of medication therapy, recommending IV to PO switches, limited antimicrobial stewardship advice, limited interaction advice, and general troubleshooting.   Other health professionals use patient ratios and caps to deal with strain on increasing demand.  Doctors for example use patient ratios to ensure that each ECG or ECHO is reported correctly and adequately, rather than compromising the quality of such reports and patient care through excess load.  Limiting activities to troubleshooting by other professionals is not accepted, and neither should it be when it comes to pharmaceutical care.7  Other authors have stated that ‘For pharmacists to be utilized to their maximum scope, we need to align our work with all of the patient’s medication-related goals, not just some of them’.7

These quality measures all support a need to examine and implement pharmacy staffing levels.

What would adequate pharmacy staffing look like?

There is a conundrum in what skills mix is required.  SHPA’s key Standard of Practice stipulates 30 as the maximum number of patients per hospital pharmacist.  Other authors offer the opinion that mortality and morbidity increases with every patient over 1:100.7  A sensible approach would be to stratify depending on acuity and clinical area such as that adopted by O’Leary et al.

Barriers

Obviously, one barrier presently to effective staffing mix, is the unrecognised position of hospital pharmacy specialists in Ireland.  The lack of a national approach to hospital pharmacy regulation is another such barrier.

It is this authors opinion that to fully realise the benefits of clinical pharmacist servicers the below actions need to be implemented:

• Implementation of the Hospital Pharmacy Review (Mc Laughlin Report)
• Expand the role of the Chief Pharmacist in the Department of Health to a Directorate of Pharmaceutical Care and Pharmacy Services. 
• Appointment of a Director of Pharmaceutical Care and Pharmacy Services at Department level with the office and resources akin to that of the Chief Pharmaceutical Officer in the UK, and on par with the Chief Medical Officer in Ireland.
• A pharmacy Act part 2 to deal with regulation of hospital pharmacy services, and provision of clinical services, that clearly designates the Pharmaceutical Society of Ireland as the regulator ad standard setting agency.
• The creation of recommended pharmacist per patient staffing ratios for Ireland, specific to specialist.
• A department (DoH) lead approach to implement these staffing ratios
• In the absence of a regulator with interest, a Directorate of Pharmaceutical Care and Pharmacy Services, and a professional body, the HPAI has been operating in a vacuum to influence and implement better pharmacy services for Irish Hospital patients.

Disclaimer

• The HPAI encourage discussion and views on the provision of hospital pharmacy services.  The above is neither a view of the Exec or intended to act as a peer reviewed piece of research.  All opinions expressed are those of the author and facilitation of those opinions on www.hpai.ie are not intended as the official position of the HPAI Executive Committee.

References

Report on the review of hospital pharmacy, Chair: Dr Ambrose McLoughlin, November 2011. [online] Available at: https://hpai.wildapricot.org/resources/Documents/Report%20on%20the%20Review%20of%20Hospital%20Pharmacy%202011%20with%202102%20JD%20included.pdf%20

HIQA. Medication safety monitoring programme in public acute hospitals – An overview of findings. Dublin: HIQA, 2018. Available at https://www.hiqa.ie/sites/default/files/2018-01/Medication-Safety-Overview-Report.pdf

Shane R, Gouveia W. The dilemma of establishing effective pharmacy staffing levels. American Journal of Health-System Pharmacy. 2009;66(23):2103-2103.

Stucky ER. Prevention of Medication Errors in the Pediatric Inpatient Setting. PEDIATRICS. 2003;112(2):431-436.

Kinahan C, Heery H. WIDE Review. Poster Presented at: HPAI Conference; 2019 April 5-7th; Dublin

IAPG.  Impact of Antimicrobial Pharmacists has been shown: a €3 return for every €1 spent on salary. 2010 Dublin

Wang E, Co M, Man D, Mabasa V. Should There Be a Cap on the Number of Patients Under the Care of a Clinical Pharmacist?. The Canadian Journal of Hospital Pharmacy. 2012;65(4).

Haggan M. Pharmacist to patient ratios matter: SHPA | AJP [Internet]. AJP. 2019 [cited 17 April 2019]. Available from: https://ajp.com.au/news/pharmacist-to-patient-ratios-matter-shpa/

O’Leary et al. Can J Hosp Pharm. 2012 Jul-Aug; 65(4): 319–321

Medicines currently benefit from free movement across Europe. For Ireland, many of the medicines on the market are dual English packs for Ireland, UK and Malta. Brexit has the potential to disrupt the provision of medicines to not only UK patients, but Irish patients too. Why is this?

The medicine supply chain is a complex International trading arrangement. Active ingredients are usually manufactured in cheaper manufacturing bases in Asia, before then being sent to a pharmaceutical company for processing into the tablet, capsule, or liquid that can be taken by a patient. These products may have time critical deadlines – short expiry dates for example adrenaline mini-jets, adrenaline auto-injectors, or may require refrigeration such as insulin biological products, and anticancer agents. Delays at ports and or airports between Ireland and the UK could result in the medicines delivered to the patient having a shortened expiry for use, pushing up the supply required per patient per year. Disruption will place substantial pressure on hospital pharmacy teams who are already continuously responding to supply issues in the present supply chain. Hospital pharmacies are scanning for potential disruptions, taking action by sourcing alternatives and working with prescribers to ensure patients continue to receive a safe supply of medicine.

The EAHP has described medicines shortages that are currently experienced in the pre Brexit era as serious, and a threat to patient care in hospitals, requiring urgent action (EAHP Practice and Policy Medicines Shortages available here). The EAHP has identified medicines shortages as a diversion of significant amounts of the time and attention of a hospital pharmacist, diverting from other tasks. Irish hospital pharmacists daily face an empty shelf when looking for potentially life altering medicines. During the ‘Storm Emma’ disruption many hospital pharmacies in Ireland had to resort to the Irish Army for deliveries of much needed medicines. Imagine a situation where these medicines are not stuck in Ireland at a warehouse, but at an international border.

Brexit has the potential to cause serious disruption to the medicines supply chain, and the British Government have identified this with calls for a minimum of 6 weeks of medicines to be stockpiled in the UK. (https://www.gov.uk/government/news/dhsc-publishes-brexit-guidance-for-pharmaceutical-industry-and-suppliers-of-medical-devices)

The HPAI as the  representative body for Irish hospital Pharmacists has written to the Minister for Health to ensure that the Government of Ireland has an awareness of this issue.

Members can view the letter and initial response on the forum.

The HPAI is awaiting a formal response, and plan from the Government of Ireland on this issue that will cause significant disruption to Irish Hospital patients, and has the potential to divert already under pressure pharmacy resources from front line clinical duties. Whilst no one wants a no deal Brexit, even a good deal may result in significant disruption to the provision of these complex goods, and the HPAI advocates that the Government with stakeholders prepare a report and work on mitigating this disruption to Irish patients.

Barcelona, Spain

Venue: The CCIB - Centre de Convencions Internacional de Barcelona

http://www.eahp.eu/congresses

The 24th Congress of the EAHP will focus on the need for tailored medication and

approach to treatment for different patient groups and individuals. We are building a

scientific programme in which the aim is to rediscover the need for tailored medication and approach to treatment for different patient groups and individuals.

The scientific program of the Congress is also tailored to the needs of individual hospital pharmacists and their interest groups as the Congress offers the possibility to choose

between many parallel sessions, keynote presentations, workshops and symposia, and plenty of networking opportunities.

The programme will serve as the source of knowledge and inspiration that is needed for our future role and engagement in personalised medication.

This is your opportunity to join experts from around the world in Barcelona to share

experience and ideas and to learn from each other and to discuss all aspects of personalised

medication under one roof.

Join us for the 24th Congress of the EAHP and enjoy an all-round Barcelona experience!

The adoption of pharmacy dispensary automation is low in Ireland. The benefits in terms of safety, stock management, accountability, security, speed and efficiency  are now well understood and have been implemented elsewhere. This tweet celebrates the replacement of automation at a well known London hospital. They have enjoyed the benefits of this central piece of infrastructure for 14 years and are now replacing with updated and upgraded hardware. 

We are in a beneficial position where hospital pharmacy in Ireland has largely missed out on the developmental and refinement pitfalls due to the low uptake and could now purchase mature offerings from vendors, if resources were made available. 

The ever increasing adoption of pharmacy dispensing automation is allowing the redeployment of hospital pharmacy teams away from traditional dispensary based activities and in to near patient clinical activities. By providing these ward based services pharmacy teams are generating both increases in the quality of patient care and ensuring the maximum return on the financial investment in costly medicines.   

After all if patients are treated optimally with their medicines and get the support to ensure they are taking them correctly they stand to get the best outcomes from treatment.  

This increasing use of specialist pharmacists in ward environments, using their in depth knowledge of pharmacotherapy is supported by the HPAI in their negotiations to enable specialist pharmacists to be recognised and supported by the largest employer of hospital pharmacists in the state. 

With a robust structure for expanding services and investment in developing hospital pharmacy around the country both patients and the taxpayer alike stand to benefit. 

If you are a hospital pharmacist member of the HPAI we are negotiating on your behalf to ensure that practice is supported and developed.  

 

The Fórsa bulletin “Pharmacist grading to be aired at WRC” was published earlier in the week here 

Firstly, thank you for maintaining your support of the HPAI, which has enabled us to get to this critical point in negotiations with the HSE.

It is more important than ever to be a member of the HPAI as it adds weight to the negotiations. Fórsa, guided by the HPAI, are the only body authorised to negotiate on terms and conditions with the major employer of Hospital Pharmacists in the State.

 If Hospital pharmacists have been waiting for the “right moment” to join, the announcement of progress on this long standing issue is a key opportunity to maximise our strength in numbers to get an agreement across the line.  Please consider asking colleagues to sign up to show their support for the development of the profession of hospital pharmacist, the recognition of specialisation, and the need for structures to drive practice development in pharmacy in the hospital sector.

This will ensure that Hospital Pharmacists can sustainably build on their existing work improving patient care, safety and providing maximum value from the use of medicines. 

We will keep members updated of any developments via the membership forum.

HPAI member and CUH senior pharmacist Dr. Virginia Silvari has been invited to join the EAHP Scientific Committee. This committee promotes professional development for European hospital pharmacists and plays an important part in organising the annual EAHP conference. 

Virginia has had a long-standing  interest in continuing education and is an active member of the HPAI Cardiology SIG. 

Following her attendance at the EAHP Pharmacy Practice Research Academy in September 2017, Virginia answered the call for expressions of interest to join the Scientific Committee. Following a rigorous selection process and two day interview, she was invited onto the Committee, along with fellow candidates Jonathan Underhill (UK) and Aurelie Guerin (France).

Virginia hopes that her participation on the Scientific Committee will give the HPAI a voice at that table and continue the long-standing commitment of the HPAI to the EAHP.

The HPAI wishes to congratulate Virginia on her appointment!