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Pharmacy dispensary services

The dispensary prepares medication for:

• Inpatients
• Outpatients
• Patients being discharged from hospital
• Clinical trials
• Birmingham Women's Hospital
• St Mary's Hospice

Drug charts for inpatient use are appropriately annotated to increase therapeutic benefit, with the addition of warnings and any other relevant information.

Prescriptions are checked for their appropriateness in both therapeutic terms and in dose, frequency and duration (especially for antibiotics). Counselling is provided for certain medication where deemed necessary.

• Outpatient prescriptions
• Ward stock
• Clinical trials
• Clinical ward services
• Medicines information (MI)
• Aseptic Production Unit
• Preparation and pre-packing services
• Community health services
• Pharmacy stores
• On-call service

Outpatient prescriptions

Charges are applicable for hospital outpatient prescriptions. Outpatients are supplied with a maximum of two weeks' medication, unless a specific course states otherwise or if the medicine is unavailable in the community.

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Ward stock

Most wards and units have their ward stocks topped up by our technicians and assistants once a week. Theatres and wards with a high usage of drugs are topped up more frequently.

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Clinical trials

A range of clinical trials are dispensed at Queen Elizabeth and Selly Oak hospitals. A large number of these trials are sponsored by the pharmaceutical industry. However, there are some that are conducted by health professionals within the Trust. These trials include different specialties e.g. neurology, liver disease, gene therapy, oncology, transplantation and others. There are two pharmacists and two pharmacy technicians responsible for the clinical trial service.

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Clinical ward services

A clinical pharmacist is assigned to each clinical speciality in the hospital. Pharmacy involvement at ward level is aimed at promoting safe, effective and economical use of drugs. Activities include a prescription monitoring service, adverse events reporting, and the provision of specialist counselling on drug therapy.

The majority of wards in University Hospitals Birmingham NHS Foundation trust and the Birmingham Women's Hospital are provided with a ward-based clinical pharmacy service. This service is provided by a designated pharmacist and technician who will co-ordinate all aspects of the pharmacy service for the wards they cover. This service includes the following:

• Taking accurate medication histories
• Providing prescribing advice
• Discharge planning / patient education
• Doctor/nurse education
• Participation in ward rounds and ward team meetings
• Improving compliance with prescribing policies and hospital formulary
• Optimising re-use of patients own drugs
• Supplying medication to wards

In addition, pharmacists provide advice on a number of drugs which require therapeutic drug monitoring (TDM). The Trust employs a system of having one pharmacist holding a TDM bleep during pharmacy hours. This allows the clinical biochemistry laboratory to contact the pharmacist directly regarding inappropriate levels etc. The pharmacist is then able to alert and advise medical staff appropriately.

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Medicines information (MI)

The MI Department at the Queen Elizabeth Hospital provides a service to healthcare professionals across the Trust.
Enquiries are also taken from healthcare professionals in primary care and members of the public. The MI Department provides a first line enquiry answering and advisory service on all aspects of drug use including:

• drug interactions
• adverse drug reactions
• compatibilities of parenteral drugs
• administration of IV solutions
• dosing and frequency of medicines
• safety of drugs in pregnancy/lactation
• safety of drugs in impaired renal/hepatic function
• administration of medication via enteral feeding tubes
• identity of foreign drugs
• provision of proactive information for both pharmacy staff and other health care professionals

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Aseptic Production Unit

Selly Oak Hospital

Aseptic services at Selly Oak Hospital are responsible for the production of parenteral nutrition (PN) infusion bags. Parenteral nutrition is where the basic components of food (fats, proteins and carbohydrates) are infused into a vein because the patient cannot eat normally or cannot tolerate feeding through a tube into the stomach, for example after an operation on the bowel.
The decision to start a patient on parenteral feeding should not be undertaken lightly, and is usually commenced after joint discussions between the pharmacist, doctor, dietitian, nurse and biochemist - the multidisciplinary team.

Queen Elizabeth Hospital

Sterile services at Queen Elizabeth Hospital are responsible for the production of cytotoxics.

All cytotoxic agents for parenteral administration are supplied to wards in a ready-to-use form (usually presented in a syringe or as an infusion bag). This is to ensure compliance with health and safety regulations relating to the exposure of staff handling these agents. Only those staff specifically trained to administer cytotoxic preparations can utilise this service.

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Preparation and pre-packing services

Non-sterile preparation includes:

• creams
• ointments
• special liquid formulations, e.g. for patients receiving treatment via NG tubes
• extemporaneous preparations

The majority of medicinal products used within the Trust are commercially available from pharmaceutical companies. However, occasionally an item is required that cannot be purchased. The range of items that can be made in our production unit includes creams/ointments, liquid formulations of certain products, eye drops and intravitreal injections.
The pharmacy prepares pre-labelled packs of tablets and capsules.

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Community health services

The Community Health Team has six members of staff, responsible for providing pharmacy services to the four Birmingham Primary Care Teams (PCTs), including supplies to the Genito-Urinary Medicine Clinic, Birmingham Dental Hospital, and Oak Tree Lane Rehabilitation Centre.

Supplies are also made to our Occupational Health Department. The team is involved with family planning, district nurses, school nurses, children's services including special school nurses, podiatry, personal dental services, optometry, walk-in centres, immunisation and vaccination, intermediate care etc.

The work is varied and includes not only the supply of pharmaceuticals but also the provision of pharmaceutical advice, development of policy and procedures, training, development of patient group directions, audit visits, answering clinical enquiries etc. It involves working with the PCTs, Social Services and education staff etc to help ensure the safe and effective use of medicines in the community setting.

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Pharmacy stores

Pharmacy stores are located at the Queen Elizabeth Hospital. The department is staffed by storekeepers, procurement and distribution personnel and ATOs. The stores section is responsible for the control of pharmacy stock in the region of £18 million per year.

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On-call service

The on-call service for the Trust is provided by a team of pharmacists with support from pharmacy technicians, who assist in the preparation of chemotherapy.