You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our site.


UKCPA Chair Mark Borthwick discusses the future of hospital pharmacy

23 Jul, 13 | by kuppell

In an interview with EJHP Mark Borthwick, Chair of the United Kingdom Clinical Pharmacy Association (UKCPA) and Consultant Pharmacist in Critical Care, John Radcliffe Hospital, Oxford talks about his views on the future of hospital pharmacy and clinical pharmacy services.

Q1) What are the challenges facing clinical pharmacy today?

A1) There are many: developing and spreading innovative practice, combating silo working, obtaining and retaining recognition for the work we already do, establishing and utilising research networks, keeping abreast of the flow of information to stay up-to-date. All of these require resource and commitment from pharmacists, no one else will do it for us.

Q2) What would you say to hospital pharmacists, especially in Europe, who don’t see the need for clinical pharmacy services?

A2) Clinical pharmacy services improve patient outcomes. Mortality and morbidity rates are improved, and costs are reduced or managed. This has been shown in numerous studies. Pharmacy provision is as much about information and using the product in its most effective way as it is about the actual product itself. As experts in medicines, we are well placed to know the nuances of why drug A gives a different outcome to drug B, we can balance the risks to give a recommendation based on our knowledge. If we have the confidence in our own abilities, then of course we should prescribe and take full responsibility for our decisions through our actions.

Q3) How can the level of research into clinical pharmacy services be increased? Who should be doing this research?

A3) We can improve the level of research by raising the expectation on pharmacists to do it. This can be done at undergraduate level and so build a workforce with the skills and belief that this is something they should do. That could take some time to feed through into tangible results. For those already working as pharmacists now, we can do something as simple as audit or start to group together to build networks. I find that groups of pharmacists are quite capable of coming up with ideas and working out how to do projects even with limited funds. Such groups naturally become more ambitious with time, building on successes and learning as they go along. They don’t have to meet physically either, they can be virtual groups linked by electronic communication lines. Research should just be part of the job, so that means pharmacists should do it, wherever they work.

Q4) Do you think European wide hospital pharmacy standards can work in reality?

A4) Such things have the feel of a self-fulfilling prophecy about them. If we all believe they will work, then they will work.  If we think ‘that’s too hard, it will never work’, then it won’t work.  I think the reality is it’s hard, but completely possible.

Q5) What would you say to those contemplating joining the hospital pharmacy profession?

A5) Hospital pharmacy is a rewarding career that requires every bit of your attention, intelligence and patience to do well. It is entirely possible to be half hearted, but then you will find it is not rewarding.  If you like to learn and like to make a difference, then there are ample opportunities to do so. I came from several years in community practice and found that my thinking was radically altered by working in hospital, in a good way. By working in the same space as doctors I realised they did not know it all, that they made mistakes and that I could stop them from doing so. More than that, I realised that my knowledge complemented theirs; together we made decisions that were more beneficial to patients and made care plans that took account of a wider variety of factors than if the plan was created by just one of the professions.

Q6) What do you think needs to be done to increase collaboration with other healthcare professionals?

A6) This links back to my previous answer; share the same space.  At undergraduate level subjects such as physiology, pharmacology, biochemistry subjects could all be taught across multiple professional groups.  After qualifying, there should be no need to separate all continuous professional development activities, some of these can continue to be shared.  Pharmacists must not be shy to approach working parties and invite themselves along to relevant initiatives (journal clubs, stakeholder meetings, guideline development groups, etc).  Pharmacists are quite capable of making their own professional treatment guidelines and disseminating to other professions.  Such activity thrusts home to other professionals just what they are missing out on when pharmacists are excluded from projects that are being set up.  In my experience such exclusion is never malicious, it’s just an oversight that is easily rectified with a bit of noise.  Set up your own working party and invite other professions to join, lead by example.

Q7) Where do you see the profession in 5 and 10years time?

A7) Difficult question, when I think back 10 years ago, we did not have competency frameworks, we did not have consultant pharmacists, we did not have prescribing pharmacists.  So much has changed radically in the UK that I may be in danger of not speculating wildly enough when looking forward.

In 5 years time we will definitely have a formal system of recognition of the different levels of pharmacy practice in the UK.  Pharmacists will be developing themselves in a more structured way to meet the needs of patients and the health service.  This will be across the profession, from pharmacies on the high street to consultant level practice in hospitals. Patients will benefit as a result, and many of the clinical skills hospital pharmacists have will be transferring to the community pharmacy setting.

In 10 years time clinical pharmacy will be the norm in the high street, just as it is in UK hospitals at the moment.  Pharmacists will be working on solid research questions and improving the health of the nation.  Community pharmacists will be offering a range of services to complement that of community based doctors.  This may well include the use of in-pharmacy diagnostic tests as the age of personalised medicine arrives and the population begins to use medicines that are most effective for their genetics and lifestyle, etc.

Changes Needed to Improve the Diagnosis and Management of CDI in Europe

22 May, 13 | by kuppell

Urgent action is needed to improve the diagnosis and management of clostridium difficile infection (CDI) in Europe according to a new report. CDI is the main cause of healthcare-associated diarrhoea in Europe and the CDI in Europe report hopes to help change the way CDI is managed across Europe at a policy level.

Written by a group of European infectious disease experts, with the support of Astellas Pharma Europe Ltd, the report points out that hospital patients with CDI are up to three times more likely to die in hospital (or within a month of infection) than those without CDI.  “CDI has an enormous impact on healthcare systems and infected patients can stay in hospital an extra 1-3 weeks at an additional cost of up to €14,000, compared with patients without CDI,” it adds.

 A number of reasons why CDI is not being well managed is identified by the report. In many countries there is an inadequate level of awareness of CDI among doctors and other healthcare workers, resulting in under-diagnosis. Where this happens treatment is delayed or omitted, leading to increased morbidity and complications in the treatment of co-existing diseases. Proactive infection control measures may also be delayed, risking further outbreaks. Additionally, only a third of European countries have a nationally recommended diagnostic test algorithm for CDI, with testing in nursing homes and the community being particularly limited.      

The report demonstrates how CDI threatens patient safety and the quality of care provided. It makes recommendations to improve CDI management, within the context of current EU policy initiatives, which call for increased awareness of the signs and symptoms of CDI to improve rates of testing and diagnosis as well as improved awareness of and compliance with guidelines for CDI therapy and infection control. The report also makes a case for the introduction of national-level surveillance systems in all Member States and increased patient education and awareness.

“It’s vital that governments see CDI management as a key indicator of patient safety and quality of care, and ensure that robust systems are in place to address it,” comments Professor Mark Wilcox, Professor of Medical Microbiology, University of Leeds and one of the CDI in Europe report authors. “CDI is a problem in hospitals and nursing homes and can be a major drain on healthcare resources. I believe implementation of the recommendations made in this Report will help improve the recognition of CDI and subsequently lead to a reduction in its incidence and impact on patients’ lives.”

A full copy of the report is available from


EAHP launch search for good practice initiatives

1 May, 13 | by kuppell

The European Association of Hospital Pharmacists (EAHP) has launched a search for examples of successful European initiatives to improve hospital pharmacy practice. The exercise is part of a project led by the EAHP Scientific Committee to create an inventory map of good practice initiatives, which they hope will provide practical support and inspiration for hospital pharmacists in EAHP member countries to embark on fresh improvement projects of their own.

The EAHP says a good practice initiative is any service improvement or innovation in hospital pharmacy conducted in the past ten years that has the possibility of transfer to other hospital pharmacy settings in Europe and encourage hospital pharmacists to take part.

Launching the exercise, Prof. Dr. Cees Neef, Chairman of the EAHP Scientific Committee, said: ‘By creating a European map of completed service development initiatives, we believe we can go some way to inspiring the next generation of innovation and improvement in hospital pharmacy across the continent. We hope all hospital pharmacies that have implemented change and improvement in the past ten years will give consideration to making a short submission for inclusion and help to build an open and accessible database of lasting value in terms of both developing new services, and enhancing the quality and safety of existing services.’

Two examples of good practice initiatives can be found on the EAHP website, one relating to a pharmacogenetics education programme in Leiden, and another a parenteral drug compounding initiative in Maastricht. The EAHP says that all examples of good practice initiatives submitted will be considered for inclusion in the inventory map, although some category areas hospital pharmacists may wish to consider include: 

  • clinical pharmacy and other HP role development 
  • clinical trials and research 
  • communication and leadership 
  • compounding/medicines production
  • education and training  
  • inter-professional and inter-sector collaboration 
  • patient safety 
  • pharmacotherapy 
  • process improvement
  • procurement, logistics and distribution 
  • resource management
  • use of technology  

The EAHP requests that initial submissions be made via their website ( by close of Friday 7th June 2013. 


EJHP launches podcasts

12 Apr, 13 | by BMJ

In a new initiative for the journal, EJHP is now publishing podcasts. The first set were recorded at the 18th EAHP Congress in Paris, and include a selection of interviews with speakers from the Congress. In an introductory podcast Phil Wiffen, editor in chief of EJHP, explains the thinking behind the podcasts, outlines the direction the journal is heading in and encourages those thinking of writing for the Journal to contact him.

One of the keynotes at the Congress, on the topic of multidisciplinary teams, was given by Dr Fiona Reynolds (pediatric intensivist and deputy chief medical officer at Birmingham Children’s Hospital) and in a podcast interview she discusses how a multidisciplinary team can be set up, how it can work in practice and what benefits it can bring to hospital pharmacy. In another podcast Joanna Correa West, medicines management nurse from Birmingham Children’s Hospital Foundation Trust considers how hospital pharmacists and nurses can work better together and ways in which they can help and support each other.

Following on from their seminar at the Congress entitled ‘Team challenges in cancer: from cytotoxics to supportive care’ Jørn Herrstedt, professor in clinical oncology, Odense University Hospital, Denmark, and João Oliveira, medical director, Instituto Portugues de Oncologia, Lisbon, share their thoughts about oncology pharmacy, improving patient safety and the role pharmacists can have in supportive care. Medication errors occur in all health settings, but there is particular vulnerability at the interface between care settings, especially at the time of admission to hospital. In an interview Jean-Hughes Dalle (professor in pediatrics, Robert-Debré Hospital, Paris) Julie Rouprêt-Serzec (clinical pharmacist, Robert-Debré Hospital) and Anthony Sinclair (director of pharmacy, Birmingham Children’s Hospital) share their thoughts  about how to improve patient safety in this area.

More needs to be done to tackle TB

27 Mar, 13 | by kuppell

European healthcare system managers and policy makers need to take proactive measures to meet the growing problem of multidrug-resistant tuberculosis (MDR-TB) and the emergence of extensively drug-resistant TB (XDR-TB) warns Dr Roberto Frontini, President of the European Association of Hospital Pharmacists (EAHP). Following on from World TB Day (March 24th) Dr Frontini said it was a time to pause and reconsider the policy options and highlighted five hospital pharmacy related measures currently available to policy-makers:

  1. Ensure hospital pharmacists are involved in medicines counselling for tuberculosis patients starting new courses of treatment in order to improve adherence
  2. Expand the role of hospital pharmacists in Therapeutic Drug Monitoring for patients with drug-resistant TB on long term courses of treatment
  3. Concentrate efforts on improving the systems for communication between hospital and community based healthcare professionals to deliver integrated and joined up care for TB patients
  4. Give hospital pharmacists a leading role in antimicrobial stewardship to help prevent further resistance to existing antibiotic treatments
  5. Redouble attention on the provision of fresh incentives for the development of new antibiotic treatments for the treatment of TB

‘The evidence is stark. There are over 380,000 reported new cases of TB in Europe each year, and the growing problem of multi-drug resistant TB is exacerbated by people not continuing their treatment for the full six months. By ensuring all professions are able to maximise the contribution of their expertise, we can reverse some of the concerning trends in the area of tuberculosis’, said Dr Frontini.

In support of the fight against TB, the BMJ Group has made its latest tuberculosis related content and products free until the end of April ( 


Medicines shortages – 99% of hospital pharmacists experience difficulties

12 Mar, 13 | by kuppell

A survey focusing on the prevalence of medicines shortages found that 99% of responding hospital pharmacists had experienced difficulties with medicines shortages in the past year. The survey was carried out by the European Association of Hospital Pharmacists (EAHP) and 346 hospital pharmacists from 25 countries took part. Sixty-three per cent of hospital pharmacists reported medicines shortages to be a weekly, sometimes daily, occurrence. Areas commonly experiencing shortages were identified as oncology (71% of respondents), emergency medicine (44%) and cardiovascular medicine (35%).

Announcing the results at an event in the European Parliament on access to medicines EAHP President Roberto Frontini said: ‘These headline results confirm what I have increasingly heard from our members across Europe: that the shortages problem is widespread, doesn’t respect national borders, and urgently requires attention if patient care and health services are not to suffer’. EAHP will present the full results of its survey at the EAHP Congress in Paris (March 13-15th, 2013).

Latest from European Journal of Hospital Pharmacy

Latest from European Journal of Hospital Pharmacy