(From left to right: Aoife Shields, University College London Hospitals NHS Trust and Rachel Dorsey-Campbell, NHS England Clinical Commissioning Pharmacist, Imperial College Healthcare NHS Trust and 2017 judge)

“It’s a great honour and I am so happy to be here. Nurses are doing great things in the face of challenging circumstances. I could not do my job without the team I work with. I love watching them develop and seeing them grow: that’s what gives me the buzz.”

Specialist MS pharmacist recognised for ‘no bloods no drugs’ safety scheme

The QuDoS recognition programme, organised by pharmaphorum and the Multiple Sclerosis Trust, recognised best practice in care. As part of a series of articles profiling the winners, pharmaphorum speaks to Aoife Shields, MS pharmacist at University College London Hospital, winner of the Outstanding Pharmacist in MS category.

Q: Please could you give an outline of the scheme?

A: Each of the MS disease-modifying drugs has a separate pathway but the principle of ensuring safe supply is the same. Each drug has a set of blood tests and/or medical examinations that must be checked and within safe limits before a patient can start or continue with treatment.

The key to the success of the scheme is that these standards have been discussed and agreed formally at our MS governance meetings and that the MS team work together to consistently adhere to the standards.

Before patients begin treatment, they have an initiation visit, where they are educated on the risks and benefits of treatment, and required pre-treatment tests are done. No patient can start treatment without meeting the drug safety standards. Once on treatment, patients have follow-up appointments scheduled in line with the required frequency of blood monitoring.

For oral drugs, prescriptions are on drug specific proformas, allowing set amounts to be dispensed before the next blood test is done. The role of the pharmacist is to ensure that the pre-treatment tests have been done and are in range, as well as checking at every dispense that bloods are done and within range.

For the intravenous or subcutaneous drugs, we plan ahead and perform checks weeks or months in advance so that the bloods or scans are done and within safe limits before the drug ever gets released from pharmacy.

Any patient whose bloods are outside of range will be recorded and discussed each week with their consultant at pre-clinic meetings. These patients will likely be followed more closely and continue to be highlighted and discussed each week until their issue resolves.

Q: What inspired you to set up the scheme?

A: My background for over 10 years was in cancer where there is national safety guidance for systemic anti-cancer therapy. In that role I created a safety checklist where specific standards must be met before chemotherapy is given to patients. The new MS disease-modifying drugs are high risk too, so it was natural that I would apply a similar safety check when our patients are receiving them.

Q: What was the feedback from patients?

A: Not all patients were aware of the need for blood tests and the reasons why. Educating patients on why the system is in place gave them a better understanding and appreciation of what the entire MS team does. Therefore, they comply with visits and tests better, and are more understanding if there is a need for extra monitoring or delay in their treatment.

Q: What plans do you have for the scheme in the future?

A: Right now, like most MS services we are working with Excel spreadsheets and still calling patients, and faxing GP practices to chase blood results. I hope that in the future the monitoring scheme will evolve within a more sophisticated national database or platform.

The benefits of this are time and cost efficiency, for instance allowing patients to get text reminders about their next blood tests; giving them the option of having tests done locally but results being accessible in primary or secondary care settings; alarms could be sent if tests haven’t been done or are out of range.

A central repository accessible to everyone for blood tests/patient details would also allow for further audit and research. I am optimistic and hopeful that this development will be just around the corner and I would love to be involved in its evolution.

Q: How did it feel to win the award?

A: First of all, I was thrilled with the nomination. For me that acknowledgement of my work was reward enough. But to win was a bonus. I have a lot of respect for my peers so to win amongst them is humbling. I’m completely shocked and surprised and very, very proud. I know my colleagues who were also nominees and I have a huge amount of respect for them.

Q: How did attending the awards meeting benefit you professionally?

A: To be sat alongside experts in the MS field is a great achievement and an inspiration.

This event was especially important to me because it boosts recognition of specialist MS pharmacists and our role within the MS multi-disciplinary team. Of course, specialist pharmacists rely on the wider pharmacy team of other pharmacists and pharmacy technicians to facilitate safe and timely drug delivery particularly when dealing with high risk, high cost drugs. This was an opportunity for me to fly the pharmacy flag for the whole profession. It was also a chance to represent University College London Hospital and the Queen Square Multiple Sclerosis Centre. Since I joined the MS service in January 2016 I have been very lucky to work with national and international figures in the treatment of the disease. I have learned a lot from them and am proud to be part of their team. They have been positive in supporting the pharmacy contribution.