Implementing and scaling of sustainable clinical pharmacy – ESCP Day 1 Highlights

The 2024 symposium of the European Society of Clinical Pharmacy, held in Krakow, Poland focused on sustainable clinical pharmacy.

In her keynote address Professor Cathy Harrison, Chief Pharmaceutical Officer for Northern Ireland, described how clinical pharmacy services are now delivered in all hospitals, general practices and community pharmacies to optimise health outcomes from medicines. This is “the green line of pharmaceutical care”, she said. Many pharmacists in Northern Ireland are already independent prescribers and a further 1000 will be added by 2030, she added.

Dr Alpana Mair presented some of the findings from the iSIMPATHY (implementing Stimulating innovation in the Management of Polypharmacy and Adherence Through the Years). This project received £31 million funding from the European Union to tackle polypharmacy in patients who were at risk of medicines-related harm.  It included patients in Scotland, Northern Ireland and Ireland. A 7-step medicines review process carried out by pharmacists focused strongly what mattered to patients.

Some 6,481 patients engaged in reviews in primary care, secondary care, outpatient clinics

and care homes with an average of 11 interventions per patient. Of these, 82% were classified as

clinically significant and 4% potentially preventing major organ failure or similar. In addition, economic evaluation identified a positive return on investment as well as a reduction in carbon footprint of both admissions and wastage of medicines.

Clozapine therapeutic drug monitoring

Monitoring of blood levels of clozapine can help to ensure that patients are neither under- nor overdosed, according to consultant psychiatrist, Dr Georgios Schoretsanitis. A case report had shown that switching from traditional cigarettes to e-cigarettes (vapes) resulted in a sharp increase in in clozapine levels and consequent drug toxicity.  Another situation where monitoring can be helpful is pregnancy. Blood volume increases as pregnancy progresses and if clozapine levels are not monitored and adjusted, they can fall below the therapeutic range.