Emergency Department Pharmacist Practitioners in the United Kingdom: a mixed-methods investigation

UoM administered thesis: Phd

Abstract

In 2015, Manchester Pharmacy School was commissioned to provide 'Advanced Specialist Training in Emergency Medicine' for pharmacists. The programme aimed to upskill pharmacists to take on a greater role in the Emergency Department (ED) and thereby supplement a shortage of doctors and nurses. Similar postgraduate training was also offered by other education providers, including Aston University who led research which hypothesised that 35.7% of ED patients could be managed by Emergency Department pharmacists who have additional clinical skills training ('Emergency Department Pharmacist Practitioners' [EDPPs]). The four aims of the research programme were to: define and describe the EDPP role; develop a specification for EDPP services; develop a framework which could be used to evaluate the quality of EDPP services; and finally, to investigate what EDPPs know and understand about safeguarding patients. Four studies were designed to achieve the four aims. For the first study, the work of EDPPs was learned through repeat completion of self-administered questionnaires. The second study aimed to develop a service specification for EDPP services, with data collected through interviews with patients who had been cared for by EDPPs, and a panel meeting with EDPPs which used a variation of the Nominal Group Technique. The specification was then reviewed by a multidisciplinary panel of those with expertise in ED care and policy. In the third study, to develop a framework of outcome indicators which could be used to evaluate the impact of EDPP services, relevant literature was reviewed, and panel meetings undertaken with EDPPs and another with other ED healthcare professionals. The fourth and final study concerned one aspect of quality care - the safety of care. Specifically, EDPPs knowledge and understanding of safeguarding patients was explored through interview, with template analysis used to develop themes. Results of the research show that EDPPs carry out both traditional clinical pharmacy work (e.g. check prescriptions for clinical appropriateness) but also new 'practitioner' work (e.g. clinically examine patients). Sometimes, EDPPs also take on the role of designated care provider with overall responsibility for patients. From the second study, patients saw value in the EDPP role, particularly for their medicines expertise and ability to relieve doctors of some hands-on clinical activity. The impact of these new activities and services on patients could be evaluated using the newly produced framework, as can the more traditional activities of EDPPs. With respect to the safety of care, EDPPs have a broad knowledge of safeguarding ED patients who have been maltreated, and felt most confident managing safeguarding issues concerning medicines. As well as use the framework to evaluate the impact of EDPP services on the quality of patient care, future research should also aim to develop care pathways for EDPPs to support the efficient and effective use of their skillset.

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Original languageEnglish
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Award date1 Aug 2020