What does a consultant antimicrobial pharmacist do?
The work of a consultant antimicrobial pharmacist involves not only knowing about antimicrobial medicines but also understanding how people and organisations behave and collaborating with others to optimise antimicrobial prescribing and improve patient care, says Neil Powell, Consultant Antimicrobial Pharmacist, Royal Cornwall Hospital.
One important aspect of penicillin allergy de-labelling is ensuring that the incorrect label does not reappear later, for example, as a result of human error or a computer error. The key to dealing with this is understanding why the label might creep in. Mr Powell says: “The ALABAMA study really sets out to try and address that …… So, we try and prevent it creeping back in by ensuring the patient understands what a negative test means and what it means for them, to ensure they’re motivated and feel safe to take penicillin in the future. You also ensure it by making sure there’s an authoritative letter about the negative challenge test so the GP has confidence that when they see this letter the patient’s gone through a rigorous de-labelling process that is robust and they can have confidence in the negative test”. He adds: “You can imagine if [as a GP] you just get a one line note from hospital ……. that says ‘this patient is not allergic to penicillin, please remove it from your records’ you can be pretty anxious about doing that without knowing who’s recommending that [and] why you’re recommending that”. He acknowledges that this is an important area that will require ongoing work.
Learning about penicillin allergy de-labelling
For people who wish to establish penicillin allergy de-labelling projects in their own hospitals a number of resources are available. Mr Powell suggests that useful starting points would be the British Society for Allergy and Clinical Immunology (BSACI) guideline for non-allergists and the algorithm produced by Sneddon and colleagues in Scotland. In addition, the British Society for Antimicrobial Chemotherapy (BSAC) is due to launch a massive, open, online community (MOOC) learning module on penicillin allergy de-labelling towards the end of October (2023).
Working as a consultant antimicrobial pharmacist
Mr Powell thoroughly enjoys his work as a consultant antimicrobial pharmacist and would recommend it to others. The job is about changing antibiotic prescribing for the better – optimising prescribing to improve patient care. However, this involves more than the technical knowledge about antibiotic therapy. Taking the example of reducing antibiotic course lengths, he explains: “So, you know the literature really supports reducing antibiotic course lengths for common infections but yet we don’t do it and even if you put it in your guidelines people don’t do it. The reason for that is around behaviour change and we’ve ignored behaviour change. When we try to change behaviour, we don’t tap into the principles of behaviour change – and for me, learning about behaviour change has been hugely interesting. So, as a pharmacist, I spend a lot of my time working out first of all what we need to do – that’s fairly easy -……. but how we do it is a real challenge. It’s a big meaty problem and that takes a lot of thinking, a lot of talking to others [and] a lot of collaboration, which I enjoy”.
“It’s not about how the tablet works – and you know we know that and that’s really interesting and that’s why we get into Pharmacy – but my role is around changing practice and how we work. It’s a harder thing to do and a more rewarding thing once you’ve achieved it and you can achieve it and so that’s why I enjoy it and that’s why I would recommend it”, he concludes.
About Neil Powell
Neil Powell is a consultant antimicrobial pharmacist at the Royal Cornwall Hospital. As Associate Director of Antimicrobial Stewardship (or two days a week) he is responsible for ensuring that the hospital is delivering on its antibiotic stewardship program of work. In addition, outside of the hospital he is responsible for ensuring that antibiotic prescribing is appropriate in primary care and the community hospitals. The remaining three days each week are devoted to research – Mr Powell is an NIHR and Health Education England (NIHR/HEE) funded clinical doctoral research fellow.