- The Dispensary
- Pharmacy Stores and Purchasing Department
- Pharmacy Clinical Services
- Ward visits
- Near Patient Pharmacy
- Aseptic Service
- CIVAS – Centralised Intravenous Additive Service
- TPN – Total Parenteral Nutrition (intravenous feeding)
- Injectable Clinical Trial Drugs
- Medicines Information
The dispensary is the area of the pharmacy department where we prepare and provide medicines to our patients. A prescription authorises us to provide the medicines to patients. There are five steps to dealing with your child’s prescription, listed below.
• When you hand in the prescription, we will ask you what form your child would prefer to receive their medicine in e.g. liquid, tablet etc. Where possible we will try to provide the medicine in the form your child prefers.
• Before dispensing the prescription it is clinically screened. This means that our pharmacist checks that the dosage of medicine prescribed is correct for your child’s age and that the medicine prescribed will not interact with any other medicine your child is taking. The pharmacist will also check that the prescription is written correctly and contains all the information needed to dispense the medicine.
• Once the prescription has been clinically screened, it is dispensed or prepared. Some medicines have to be made up especially for your child so these may take a little longer.
• The medicine is checked once more to ensure that the information given on the medicine label is the same as on the prescription and then packed in a bag ready to be given to you or sent to your child’s ward.
• When we give your child’s medicine, we will ask you to confirm some of their details again to make sure that you are receiving the right medicines. We will explain each item to you, telling you how to give it and how often. If we have some written information about your medicine we will provide that to you as well. You can also ask us any questions before you leave.
Pharmacy Stores and Purchasing Department
Our purchasing department work to obtain the right medicines at the best possible price. They work closely with other children’s hospitals and under national guidance to achieve this.
Some of the medicines that we use at Alder Hey have to be specially prepared for our patients. We must make sure that these medicines are of high quality and the purchasing team work with the Quality Control North West laboratory to make sure that these medicines are properly tested.
Some children with long term conditions can receive complicated therapy in their own homes. The purchasing team work with special homecare service providers to make sure that the medicines and all of the other necessary equipment can be delivered directly to the home, helping to make things a little bit easier for parents to manage.
Pharmacy Clinical Services
Our wards are usually visited by a clinical pharmacist on a daily basis (Monday to Friday). During their visit they will review prescriptions and provide advice on medicines to the nursing and medical staff as well as to patients and their families.
The medicines on the prescription are checked:
- To see that they are suitable for the patient and their illness
- To make sure that they follow hospital guidelines
- To check that new medicines that have been introduced will not affect any existing medicines
- Side effects
The pharmacists will also provide advice on how to monitor medicines and will review your child’s response to the treatment. If required, pharmacists may also provide information about the medicines to children and their families before they are discharged.
Near Patient Pharmacy
Many of the wards have a Near Patient Pharmacy Service which involves ward based pharmacy staff. As well as providing the clinical pharmacy service outlined above, the pharmacist and technician team will take a medicines history from the patient/family, assess the patient’s own medicines and use them during admission, if appropriate. Sufficient amounts of all medicines likely to be needed when the patient is discharged, are individually dispensed for the patient and stored separately from other patients’ medicines and then used until the patient is ready to go home. This service has greatly reduced waiting times for medicines on discharge and allows patients and their families to have more contact with pharmacy staff and ask any questions about their medicines. This service also provides extra support and advice for medical and nursing staff and has helped to reduce the incidence of medicines waste and medication errors. Please remember to bring your medicines with you if you are admitted to hospital
The UK Department of Health recommends that intravenous injections and infusions are prepared under controlled (sterile) conditions within a pharmacy department, away from the busy ward environment.
Our pharmacy department has a large aseptic services unit specially designed to prepare many of the injectable medicines used to treat patients attending the day-case ward and in-patients on other wards. Products are prepared by pharmacy technicians and assistants who wear special clothing and work in special cabinets (known as isolators) to protect the product. The unit is working towards becoming a fully licensed unit to allow us to make more products with a longer shelf life.
Pharmacists, technicians and assistants working in the unit prepare four different types of sterile products: CIVAS doses, TPN (Total Parenteral Nutrition), Chemotherapy and Clinical Trial Drugs for injection.
CIVAS – Centralised Intravenous Additive Service
This part of the Aseptic service produces up to 90 different types of “ready to use” injections or infusions for in-patients and day case attenders, including antibiotics to treat infections, epidurals for pain management, and monoclonal antibodies used to treat conditions such as arthritis and inflammatory bowel diseases.
This service is particularly helpful to nursing staff because it avoids the need for them to prepare injections on the ward.
TPN – Total Parenteral Nutrition (intravenous feeding)
Total Parenteral Nutrition (TPN) is a complex mix of glucose, protein, water, salts and fats. It is used to treat children who cannot maintain growth and development by normal eating methods. This may be because the gastrointestinal tract (gut) is unable to digest and absorb nutrients (such as glucose, protein fat, vitamins and salts) in the right quantities. Under these circumstances it is necessary to provide nutrition by giving a special solution (TPN) directly into the vein (intravenous feeding).
In some patients TPN is used for a short time to allow their gut to rest e.g. after surgery. Other patients may require lifelong TPN therapy. It is possible for these patients to have their TPN at home and many can have the infusion given just overnight.
Our method of TPN preparation uses a state – of – the art automated system with bar code and touch screen technology.
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Within the Aseptic cytotoxic unit we prepare these drugs using safe handling techniques in a specially designed cabinet (isolator). This makes sure that the product and the staff handling the product are properly protected. Each year we prepare approximately 5,000 doses of chemotherapy in the unit.
Injectable Clinical Trial Drugs
We work closely with the research department in the Trust to make sure that we help to research new medicines for use in children. This research is done as part of a clinical trial. Some clinical trials require preparation of injections of clinical trial drugs under sterile conditions. Often these research drugs have short shelf lives and require preparation and administration within as little as 15 minutes. The Trust’s research facility and reputation are expanding and this part of the aseptic service has also needed to expand.
Pharmacists and technicians working in this area of Pharmacy support nursing and medical staff with advice on choosing and administering medicines for children. They answer enquiries and provide information to healthcare professionals in the hospital on a wide range of topics including:
• Medicines administration
• Appropriate choice of therapy
• Adverse drug reactions (side effects)
• Drug interactions (how medicines behave when they are given together)
• Availability of preparations
• Identification of tablets/other substances
In addition to answering enquiries staff also:
1. Prepare and maintain guidelines on preparation and administration of injections for nursing staff to use on the wards
2. Review new medicines that become available and make sure that we have enough information about using them in children
3. Prepare medicine updates to help healthcare professionals keep up to date with new therapies.
4. The Medicines Information department has a lot of useful information including a wide range of reference texts (particularly children’s dosage books) and a large database of previous enquiries about using medicines. They also have links with other children’s medicines information pharmacists working across the UK and abroad.
5. At the moment we are not able to answer questions directly from members of the public or patients, but this is something we would like to do in the future.