A survey exploring the barriers and drivers to leader and leadership development of the pharmacy workforce

INTRODUCTION

Leadership is an essential but under-researched domain in advanced pharmacy practice.

AIM

To describe pharmacist leadership training experience and ascertain perceptions of barriers/drivers for leadership development.

METHODS

Online survey at a UK tertiary-care organization. Questions related to leadership competencies, personal qualities, barriers, and drivers, with Likert scale responses options, were analysed using Microsoft Excel®.

RESULTS

Thirty-nine pharmacists responded. Three quarters reported no formal leadership training. Many identified leadership development as essential for career progression. Main driver was a manager or peer support. Barriers included workload, being undervalued, and lack of strategic opportunities.

CONCLUSION

Our findings can inform educators and organizations in developing future strategies.

Critical care pharmacist research activity, experience and interests: a 2021 United Kingdom survey

BACKGROUND

Research and innovation are essential for effective healthcare service delivery, leading to improvements in patient health and wellbeing. National policy dictates that research delivery is embedded into daily practice of United Kingdom (UK) healthcare professionals, including pharmacists. There is a limited understanding of critical care pharmacist research activities, experiences and interests. It is, therefore, important to describe current practice including barriers and facilitators to enable increased engagement.

OBJECTIVES

To describe UK critical care pharmacist research activity, experiences, interests and barriers to better engagement.

METHOD

An electronic survey was developed, piloted and distributed (June to October 2021) to all critical care pharmacists via UK professional organisations.

KEY FINDINGS

The survey was completed by 126 pharmacists, providing a 54% response rate. Few pharmacists reported research capability (postgraduate qualification with a research component, 31% (39/126)) and opportunity (dedicated research time, 28.6% (36/126)), only 12.7% (16/126) have both these influencers. Those that did, produced significantly more research outputs (median 4 (0,9) versus 0 (0,1), P = 0.023) and undertook grant funding applications (X2 (1, n = 126) = 25.8, P < 0.001), compared to those without. The most frequently reported barrier to research was the time (opportunity), (71.4%, 90/126). Few pharmacists reported having a research mentor (13.3%, 16/120). Most pharmacists reported an interest in collaborating on research projects across a broad range of areas.

CONCLUSIONS

Critical care pharmacists are motivated to participate in the evaluation continuum including research, although most report capability and opportunity barriers to delivery. We suggest policy recommendations to address limitations and increase pharmacist research involvement.

An audit of the pharmacological management of patients experiencing acute alcohol withdrawal at a large tertiary centre

Introduction

Alcohol has depressant effects on the central nervous system through its effect on inhibitory GABAA receptors. In chronic excessive alcohol use, GABAA receptors undergo neuroadaptation, and so, in abrupt alcohol withdrawal upon admission into hospital, the central nervous system remains in a hyperactive state, resulting in alcohol withdrawal syndrome (AWS), and can progress to seizures and delirium tremens if not managed appropriately. National guidance recommends validated tools such as the ‘Clinical Institute Withdrawal Assessment – Alcohol, revised’ (CIWA-Ar) scale and use of benzodiazepines and thiamine for AWS management. Within our organisation, pharmacists and the Alcohol and Drug Liaison Nurse (ADLN) specialists have noted variability in AWS management.

Aim

This project aimed to investigate the compliance to local and national guidelines in the management of AWS.

Methods

A retrospective audit (for which ethical approval was not required) was conducted using the electronic health record system to identify high-risk drinkers on the acute medical unit (AMU). A report of AMU admissions from 1st to 30th April 2020 was obtained and identified 44 patients with AWS. Patient records were analysed to assess compliance to the following standards: Standard 1 was that 100% of patients must have a completed AUDIT-C form on admission; Standard 2 was that 100% with AWS must have a CIWA-Ar score recorded every 4 hours on day one; Standard 3 was that 100% must be prescribed a benzodiazepine reducing regimen as per guidelines; and Standard 4 was that 100% with malnourishment or who will continue to consume alcohol must be discharged with thiamine 200-300mg daily.

Results

For Standard 1, 2% of patients (n=1) had AUDIT-C forms completed. For Standard 2, 14% (n=6) had a CIWA-Ar score measured every 4 hours on day one. For Standard 3, 23% (n=10) were prescribed benzodiazepine fixed-dose reducing regimens according to their CIWA-Ar score. 23% (n=10) had no benzodiazepines prescribed and 30% (n=13) were only prescribed a ‘when required’ benzodiazepine. 48% (n=21) were prescribed a regular benzodiazepine initially rather than a reducing regimen. Of these, 62% (13/21) were commenced on an appropriate dose according to their CIWA-Ar score. For Standard 4, 34% (n=15) were discharged on oral thiamine 200-300mg daily. 27% (n=12) were discharged without thiamine.

Discussion/Conclusion

The use of AUDIT-C forms was not routine practice. This may lead to under-detection of patients experiencing AWS resulting in treatment delays. CIWA-Ar scores were rarely carried out every 4 hours on day one, perhaps highlighting a need for guidance on frequency of CIWA-Ar assessment. Ten patients with AWS were not prescribed a benzodiazepine. This could have been due to a lack of awareness of guidelines, or that simplification of current guidelines is required. Limitations of this audit include that it did not explore clinical reasons for deviations from guidelines or any additional specialist advice sought from ADLN. As such, it cannot be assumed that all deviations from guidelines were inappropriate. No audit standards were met, highlighting a need to improve management of AWS in a hospital setting.

References

1. NHS Digital. Statistics on Alcohol, England 2019 [PAS] [Internet]. 1 February 2019. [accessed 12 May 2021]; Available from: https://digital.nhs.uk/data-andinformation/publications/statistical/statistics-on-alcohol/2019

2. Kumar S, Porcu P, Werner D, Matthews D, Diaz-Granados J, Helfand R et al. The role of GABAA receptors in the acute and chronic effects of ethanol: a decade of progress. Psychopharmacology [Internet]. 2009 [cited 30 July 2022];205(4):529-564. Available from: https://link.springer.com/article/10.1007/s00213-009-1562-z

3. National Institute for Heath and Care Excellence. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking and alcohol dependence [internet]. 02 June 2010. [accessed 30 July 2022]; Available from: https://www.nice.org.uk/guidance/cg100/chapter/Recommendations#acute-alcohol-withdrawal

A survey exploring the barriers and drivers to leader and leadership development of the pharmacy workforce: a focus on advanced practice

Introduction

Developing professional leadership skills is one of the workforce development goals of the International Pharmaceutical Federation1. Leadership is identified as an essential domain in advanced practice curricula for pharmacists in the United Kingdom2. The National Health Service People Plan recognises that leadership training and development can maximise productivity and shape a positive culture, which is essential for provision of 21st century healthcare3. However, leader and leadership development remain under-researched within the pharmacy profession.

Aim

To describe pharmacist leadership training experience and perceptions of barriers and drivers to leader and leadership development.

Methods

An online survey was developed, piloted, and distributed to 105 pharmacists at a single, tertiary care, acute hospital organisation in the UK between August and October 2020. The survey consisted of Likert scale questions relating to importance of leadership competencies, personal leadership qualities, barrier, and drivers to pharmacist leadership development. Quantitative data were analysed using Microsoft Excel®. The study formed part of a local pharmacy service education and training service evaluation and review. Therefore, in accordance with the Health Research Authority toolkit NHS ethical approval was not required.

Results

The survey was completed by 39 pharmacists, providing a 37.1% response rate. Almost three quarters of pharmacists did not have leadership training. Over half the pharmacists surveyed identified leadership development as essential for career progression (n=26, 66.6%) and to improve performance in their current role (n=23, 59.0%). A key driver was support from line managers or work colleagues (n=28, 71.8%). Pharmacists reported workload (n = 19, 48.7%), not being valued (n=16, 41.0%) and lack of access or opportunity to work at strategic level (n= 14, 35.9%) as barriers to pharmacy leadership development.

Discussion/Conclusion

This is the first survey of pharmacist leadership development among pharmacists working in the hospital setting in the UK. Improving performance in current role and career development were identified as key drivers for pharmacist leadership development while workload and lack of access or opportunity of working at strategic levels were identified as key barriers.

References

1. Leadership Development [Internet]. FIP Development Goals. [cited 2022 Apr 14]. Available from: https://developmentgoals.fip.org/dg6/

2. RPS Advanced Pharmacy Framework.pdf [Internet]. [cited 2021 Dec 10]. Available from: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Frameworks/RPS%20Advanced%20Pharmacy%20Framework.pdf

3. NHS England » NHS People Plan [Internet]. [cited 2022 Apr 14]. Available from: https://www.england.nhs.uk/ournhspeople/