2.1 Introduction
Pharmacists play a key role in public health and the use of medicines, as well as to participate actively in the prevention of disease and promotion of wellbeing. One of the most important roles of pharmacy workers is to provide advice and treatment for self- care. Self-care strategies are expected to help reduce the burden on the UK healthcare system.
Self-medication is an important component of healthcare and involves the selection and purchase of drugs that are suitable to the patient's unique health condition. The pharmacy team plays an important role in providing the patient with information regarding dosage, side-effects and duration. It is the responsibility of the pharmacy team to ensure that practices are implemented within the regulatory frameworks. Patients should enjoy access to drugs that are certified with the highest degree of safety and efficacy. Pharmacy teams should also consider improving their approach by taking a closer look at the perceptions and attitudes of the patient.
Every pharmacy team worker in the UK is bound by a set of rules laid down in the Code of Ethics stipulated by the Royal Pharmaceutical Society of UK. These rules have been formulated to promote trust and reliability, as well as to maximise patient experiences and outcomes. The Code of Ethics consists of seven fundamental principles, which include honesty and integrity, development of knowledge, encouraging patients to participate in healthcare, showing respect, exercising your professional judgement and making patient care your first priority.
2.2 Pharmacy Practices
Self-care and Self-Medication
According to the Charter of Collaboration between the PGEC (Pharmaceutical Group of the European Community) and AESGP (European Proprietary Medicines Manufacturers Association), the pharmacist is qualified to provide reliable advice regarding the medicines dispensed by them, as they are in direct contact with the client.
In the UK, for example, people are increasingly opting for self-care, as opposed to waiting in queues to meet a GP. A pharmacist can help people make informed self-care choices Patient self-care is based on the assumption that patients use safe and effective medication, which is suited to their individual needs.
Pharmacists must take a closer look at the following three factors, with respect to self- care:-
Providing advice and recommendations pertaining to the ethical and technical issues regarding self-care. This could include issues such as dosage, frequency and side-effects. Due consideration to determinants and factors regarding implementation of health checks and prevention of disease.
Key features of self-care and self-medication.
Self-medication is a component of self-care and involves the selection and use of medicines for ailments recognised by the individual. Patients treat themselves with drugs or medicines available at the pharmacy that do not require a prescription from a certified GP. These medicines are also considered safe, when used as directed in the instructions. Responsible self-medication practices can be consolidated and monitored by pharmacy teams to a large extent.
Responsible self-medication would include:-
The medicines distributed should be of proven efficacy and safety and formulated by reputed manufacturers. The medicines used by the patient should be intended for a specific recurrent or chronic condition and should be accompanied by the appropriate dosage forms.
Self-medication products should always be supported by the following information (which is the responsibility of the pharmacy team to provide):-
-How to take the medicines (before/after eating, etc)
-Effects and possible side-effects (drowsiness or loss of appetite, etc)
-How to monitor the effects of the medicine (observation of progress)
-The likelihood of drug interactions (if the patient is consuming multiple drugs)
-Precautions and warnings (avoiding over-dosage, avoidance during pregnancy, or store under cool conditions, etc)
-Duration of usage
-When the patient should seek professional advice
2.3 The Increasing Significance of Self-Care Healthcare Practices
The role of the pharmacy has evolved over the last two decades. The role of the pharmacist is no longer confined to the dispensation of medicines. Pharmacists are now considered an active provider of healthcare in hospitals, communities, laboratories, industries
and ambulatory services.
As the challenges of healthcare grow, the pharmaceutical sector is becoming a significant partner in the implementation of healthcare objectives. From the point of view of the pharmacy teams, increased involvement in public healthcare implies greater levels of responsibility towards patients and increased accountability. The increased emphasis on self-care amongst British citizens is due to several reasons, including improved access to drugs, improved potential to manage minor and chronic ailments and greater availability of medicinal supplies.
The profile of patients has also evolved in the 21st century. Growing empowerment that is a direct result of increased information and education related to healthcare (pharmacies are responsible for promoting health literacy), as well as a growing demand for participation in healthcare decisions. Patients have access to a wealth of healthcare information and there is also an increased interest in personal health and wellness.
'Over the Counter'
Self-medication drugs are often referred to as 'Over the Counter' or OTC medicines. Patients decide to purchase a medicine or use a drug, based on the information listed on the label. When the patient seeks assistance at the point of purchase (usually a pharmacy), this is called “facilitated self- medication”. The trained staff members at a pharmacy are in a strong position to advise the patient regarding the drug. In fact, their information has a significant impact on the patient's purchasing decision.
The pharmacy team is in a position to positively shape the customer's decision and to help provide guidance on alternatives. The promotion and support of self-care and self-medication plays a crucial part in the reduction of healthcare costs. Community pharmacy teams, for example, are placed in a unique position to offer advice to patients, in comparison to other healthcare professionals. Community pharmacists usually enjoy a high level of public trust.
FACT
The NHS announced a pharmacy integration fund of £42 billion on 20 October 2016. The “Pharmacy Integration Fund” is expected to support and implement community pharmacy initiatives.
Source: england.nhs.uk
2.4 Reclassification of Prescription Medicines
In the UK reclassification of prescription medicines as non- prescription medicines is one of the main components of healthcare policy. Regulatory frameworks in the UK are advocating the idea of “pharmacy medicines” that can only be dispensed at a pharmacy, or under the supervision of the pharmacy team. Pharmacies handle and manage a large number of consumers seeking non-prescription drugs.
Regulatory authorities are now reclassifying prescription drugs for chronic conditions as non- prescription drugs, in order to reduce the burden on healthcare systems in a responsible manner. Such reclassification of medicines and the ready availability of non-prescription drugs may herald a new era in the management of chronic conditions and pharmacy teams will now be in a position to support chronic patient care to a more significant extent.
The expansion of non-prescription drugs has enabled community pharmacies to demonstrate the tangible beneβits of these medicines to patients. In the UK, government endorsed and funded pharmacy patient care schemes such as the “minor ailment scheme” and the “Healthy Living Pharmacy Scheme” have had a positive impact on community healthcare.
Whilst self-care is undoubtedly the answer to reduced healthcare costs and improved patient outcomes, there are several barriers to implementing effective self-care. One of the main challenges is to improve confidence levels in the pharmacy teams, so that they feel empowered to take on new responsibilities in healthcare. Lack of training and know-how may impede pharmacists from facilitating self-care and self-medication schemes.
Pharmacy teams also need be trained to interact more actively with patients and ask more questions regarding their symptoms. This challenge further suggests that pharmacies should make appropriate use of staff members and need to balance their efforts between pharmacy and non-pharmaceutical activities. Community pharmacies, for example, often function as the interface between the patient and managed healthcare and act as a filtering mechanism between the two.
However, this relationship is usually hampered by an excessive degree of informality between physicians and pharmacy teams. There needs to be added structure and definition to the pharmacy team/medical care staff relationship, so that facilitated self-care can be promoted on a larger scale. Research studies indicate that doctors are extremely supportive of pharmacy teams for the implementation of medicine dispensation, provision of information and reducing wastage.
However, they are not as cooperative when it comes to endorsing pharmaceutical services that were traditionally considered GP practices. Such services include treatment of minor ailments and chronic symptom management. The healthcare system requires new pathways that are able to forge coordination between consumers, pharmacy teams and medical practitioners. The good news is that recently, several new drug products have been developed as non-prescription drugs.
Activity 1
Estimated time 10-15 minutes
Take a notepad and pen and answer the following questions:
How do you think pharmacy workers can help in reducing costs and improving healthcare services?
How will this help doctors and GPs?
2.5 Code of Ethics for Pharmacy Team Workers
Registration as a pharmacy assistant or technician is associated with certain rights and duties. The Code of Ethics is issued by the Royal Pharmaceutical Society of Britain.
Overall, the Code of Ethics requires a pharmacy team worker to:-
-Maintain good relationships with other people.
-Use your knowledge and skills for the beneβit of patients or others who seek your professional expertise.
-Act in a manner that helps promote trust and reliability in the pharmaceutical sector.
The Code of Ethics is a set of rules and regulations which you, as a pharmacy worker, must follow. The principles of the code are designed to promote your work and help you to make the right decisions. The Code of Ethics also aims to educate the public about the standards of profession that they can expect from the pharmaceutical sector.
There are seven main principles governing the Code of Ethics for the pharmacy profession. In general, the seven principles encapsulate what it means to be a registered pharmacy team worker. Incorporating these seven principles into your professional life will help you to maintain patient safety and increase public confidence in the pharmacy profession. It is crucial to be familiar with the seven principles, because as a pharmacy team worker, your professional and personal conduct will be judged against the seven principles. Failure to comply
with the rules, or disreputable behaviour, could put your registration at risk.
Pharmacy team workers (including assistants and technicians) undertake to support, develop, or undertake pharmaceutical services. Every professional is responsible for his or her own behaviour or ethics. The Code of Ethics promotes accountability and responsibility. In other words, you must take responsibility for your own actions or omissions, regardless of advice from other people in the pharmacy team. If required, you must be able to justify your actions in the light of the Code of Ethics (if asked to do so). From time to time, you will be faced with conflicting situations that require to evaluate risks and benefits in accordance with the Code of Ethics. In every case, your decisions must be consistent with maximisation of patient outcomes and reinforcement of public trust.
2.6 The Seven Principles
The seven principles governing the Code of Ethics for pharmacy team workers are explained below:-
1. Patient care should be your primary concern
Patient care should be a continuing concern for every pharmacy worker. Please remember that even if your work does not involve direct contact with patients, you must act with a view to improve patient care, as your actions can still have an impact on patient safety. You must ensure that you seek all available information with regard to a patient's care. In addition, you must promote patient health and safeguard the wellbeing of patients (especially with regard to vulnerable patients, such as children or the elderly).
Wherever necessary, you must take care to refer the patient to a primary care provider or other care services (such as social care). Pharmacy assistants and technicians must also ensure that patients are able to enjoy easy and timely access to medicines and must invest effort into cross-checking the suitability of the medicine for the patient's requirements.
As a pharmacy assistant, you must also ensure that the patient or caregiver knows how to take the medicine. This can be a particularly challenging aspect when it comes to dealing with patients from different ethnicities and backgrounds. It is also the job of the pharmacy team to maintain accurate and updated records, as well as to ensure that the pharmacy team should also undertake regular audits, reviews and risk assessments, to ensure that high quality of services. For example, you must regularly check for expired drugs and discard them, in order to reduce risks. Regular checks and audits will also help to ensure that products (supplies, medications, etc) are of high quality.
2. The pharmacy team worker should exercise his or her judgement in the best interests of the public
The pharmacy worker may need to balance competing professional requirements, along with patient needs. Whilst you must consider taking into account guidelines, βinancial constraints and targets, it must not be allowed to disrupt making professional judgements regarding the best outcome for the patient. Whilst acting in a professional capacity, you must ensure that you act in the best interests of the public and individual patients. Similarly, pharmacists and assistants should ensure that personal interests, targets or incentives do not interfere with making the best decisions.
For example
A drug manufacturer may offer financial incentives to sell a non-prescription drug. However, the pharmacy technician or assistant must not sell the medicines without cross-checking the patient requirement. In addition, pharmacy team workers should maximise the use of resources available to them. They should also challenge the opinions of co-workers and other healthcare staff, if the care and safety of a patient is at stake. Pharmacy teams should also obtain permission from regulatory authorities, during the course of development and research. In emergency situations, ensure that you take appropriate steps to reduce risks to the patient, whilst taking into account other care service options available.
Activity 2
Estimated time 10-15 minutes
Write a few sentences explaining how you can improve your services to the public, without allowing your judgement to get clouded by a conflict of interest.
3. Show respect for other people
Pharmacy workers must demonstrate respect for the rights, views and dignity of patients, caregivers, colleagues and co-workers. They must strive to develop professionally appropriate relationships with anyone they come into contact with. Pharmacy assistants and technicians must learn to respect cultural differences, beliefs and attitudes that may seem different to your own. You must treat people with politeness and respect, under all circumstances.
In particular, you must ensure that your perceptions regarding a patient's gender, race, ethnicity and beliefs do not colour your ability to provide the best services. In cases where your beliefs or religion prevent you from offering a specific service, refer the patients to alternate providers, so that patient safety is not compromised.
An extremely important concern in a pharmacy environment is patient confidentiality. Every pharmacy worker must ensure that unauthorised access to confidential information is minimised. It is extremely important to respect the privacy and dignity of others. If you have to disclose confidential patient information, ensure that you have the necessary permission to do so.
For example
If a patient is moving away to another town, you may need to transfer information regarding his medication to another pharmacy. If you need to do this, you should consider obtaining his permission first. However, in certain exceptional cases, you may be required to disclose patient information. Ensure that you do so, according to the law. Any patient information should only be used for the purpose for which it was given, or for other lawful purposes. It is extremely difficult to maintain professional boundaries with the patients that you come into contact with. You must be especially cautious, when it comes to vulnerable individuals.
4. Pharmacy workers must encourage patients to participate in their own medical care
Patients should participate in their treatment or care and as a pharmacy worker, you should encourage them to work in partnership with the pharmacy team. In order to develop successful partnerships with patients, it is important to communicate clearly and identify the patient needs. In the cases of patients who are legally or medically incapable of making decisions, the pharmacy team must communicate with caregivers, or a person who is authorised to make decisions for them. Whenever possible, work together with the patient, healthcare professionals and caregivers, to maximise patient outcomes. You can help the patient to make informed decisions, by explaining the available options. Learn to listen carefully to patients and strive to meet their communication needs.
Communication should be able to straddle cross-cultural differences. Pharmacy workers should ensure that they share information with the patient or caregiver in a way that they are able to understand.
For example
If you are communicating with a non-English speaking patient, avoid using complicated pharmaceutical jargon. You can replace “sedative tablet” with “a tablet that helps you to sleep better”. It is extremely important to respect a patient's decision to refuse pharmaceutical or healthcare treatment or services. In addition, you should address factors that prevent or hamper a patient's efforts in accessing treatment and services.
For example
If a patient is physically unable to walk to the pharmacy, you can check if the pharmacy is able to deliver the medication to them.
5. Every Pharmacy Assistant, Technician and Worker must develop their Knowledge and Competence
At all stages of your career as a pharmacy worker, regardless of whether you are just starting out or are an experienced veteran, you must endeavour to offer the highest quality of skills, performance and knowledge. Moreover, your knowledge must be relevant and updated. It is important to maintain and improve the quality of your work, by working to keep your knowledge updated.
A pharmacy worker should be able to apply skills and knowledge appropriately to his responsibilities. It is equally important to recognise the limit of your professional competence. Practice your responsibilities only in the areas where you are competent to do so and for other additional help, refer the matter to other professionals.
For example
You may be providing a patient with eye drops for eye fatigue on a regular basis. If the patient develops eye infection, you should refer the patient to a doctor. It is also a good idea to adopt a proactive attitude with respect to ongoing training. For example, consider responding constructively to performance reviews and undertake additional training, if required.
Most importantly, practise pharmacy only if you are βit and competent to do so. If you suffer from mental or physical illnesses that prevent you from practising, ensure that you inform your supervisor.
6. Honesty and Trustworthiness
In general, the public, patients and colleagues are likely to place a lot of trust in you as a pharmacy professional. Make sure that you behave in a manner that helps to justify that trust and maintain the dignity of your profession. Always act with honesty and integrity and avoid exploiting vulnerability in others. You must also take care to avoid taking advantage of patients who lack knowledge about pharmaceutical care. As far as possible, avoid conflicts of interest and do not accept gifts, money, or hospitality that may be perceived to impinge on your integrity or professional judgement.
Ensure that your attitude is impartial and non-judgemental when teaching others. Develop a courteous and honest attitude towards patients and colleagues and anybody you come into contact with. Pharmacy workers must ensure that they honour professional arrangements and commitments, so as to provide the best standards of pharmaceutical care.
7. Be ready to take responsibility for your practices
Positive working practices include effective communication with colleagues and ensuring that you contribute positively towards their training and development. Share your skills and knowledge willingly and ensure that accountability procedures are put in place. Take responsibility for your practices, as well as those who are working under your supervision. Also make sure that your practices are covered by suitable indemnity procedures and have a complaints procedure in place, in order to address grievances. Pay special attention to concerns which may compromise patient care.
MODULE SUMMARY
One of the most significant points of pharmaceutical care is providing support for self-care and self- medication practices. The role of pharmacy teams as well as profile of patients has evolved, over the past two decades. Due to an increased interest in personal health and a greater desire for participation in treatment, self-care is an option preferred by thousands of people. It is the responsibility of the pharmacy team to provide comprehensive information regarding the drug, its benefits, side-effects and so on.
Pharmacy teams have a responsibility with regard to the implementation of ethical practices, in accordance with regulatory laws in the UK. One of the most significant steps towards consolidating the role of pharmacies in healthcare has been the reclassification of medicines for chronic ailments as non-prescription drugs. The expansion of non-prescription drugs has improved the scope of pharmaceutical in the management of chronic ailments. The pharmacy team is able to implement “facilitated self-medication” options.
The Code of Ethics is a set of rules issued by the RPS (Royal Pharmaceutical Society) and this must be adhered to by all pharmacy workers in Britain. Failure to follow the Code of Ethics may result in punitive action or penalties. The role of pharmacists in the issue of self-care must be well defined. Their contribution is not just important at the community level, but also at the national level, especially with regard to distribution of important drugs. Pharmacy teams also need to consider quality assurance issues and regulatory aspects, as well as consumer perceptions and attitudes.
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