Inside Addenbrooke's pharmacy: The hospital's beating heart
The pharmacy is the beating heart at the centre of Addenbrooke's Hospital, and is responsible for reducing pain, fighting infections and improving the quality of life of patients.
Each month, its dispensing service supplies 30,000 items to hospital patients, from packets of paracetamol to potentially life-saving cancer treatments.
Cambridge University Hospitals NHS Trust employs around 230 pharmacy staff based across six departments, which each has a vital role to play.
The dispensing service is provided by the inpatient pharmacy to all patients and ward-based outpatient clinics in both Addenbrooke’s and the Rosie Hospital.
Pharmacists check prescription choices and assure patient medication safety while technicians ensure patients admission medication is checked, and new supplies made to ensure continuity and efficient discharge.
Inpatient pharmacy technician Alexandra Suvorov, 38, has worked for the trust for the past 11 years.
“All the prescriptions now are in the computer,” she explained.
The digitised process means that doctors and consultants write the prescription which is checked by a pharmacist and then it is given to the pharmacy to be dispensed – with the help of a robot.
“The robot is already thinking about it as soon as you press ‘print’,” said inpatient pharmacy manager Matthew Watkins, 35, as the robot selects the correct medication before heading down a chute ready to be labelled. The automated system was introduced 17 years ago and has revolutionised the process, and since then it has continued to improve.
“The whole reason is for patient safety,” Matthew explained. “You find that so many medications look and sound very similar and the potential for mistakes is huge. Clinical knowledge is part of the pharmacy profession and as a registered professional we have to maintain a certain understanding and competency and developing that is one of our main protocols.”
The dispensary has a targeted turnaround time of 90 minutes for patients who have been discharged.
The pharmacy stores and distribution centre is where pharmaceuticals are received and distributed to other parts of the department, plus all wards and clinics. The procurement of drugs is managed in the central pharmacy.
“Within the department here every medicine that is used in the hospital comes through those doors, so we see everything that comes in and we distribute it from here,” transformation project manager, Gail Garood said.
She continued: “Our role here is checking the goods when they arrive, storing them correctly and making sure that we pick them correctly and that our stock is correct – for example, changes depending on the season so it’s different in winter than in the summer.”
There are 8,000 drugs on the hospital’s drug file but the trust only stocks a proportion of these.
“It’s the ones that are either the high-use drugs or things that are needed quickly like antidotes or antibiotics and things like that, which we routinely keep in stock,” said Gail.
The department also deals with the collection of bulk fluids and IV fluids – each month it moves 16 tonnes of these.
Senior pharmacy assistant Alison Smith, 53, joined the trust in 2014 where she has trained on-the-job to reach her current position.
“People don’t realise that we’re down here,” she said. “There are lots of things here that people wouldn’t think about – we even keep leeches in stock.”
Former retail worker Zoe Cooper, 40, trained as a pharmacy technician in Boots before coming to Addenbrooke’s almost 12 years ago. Principal technician Zoe is part of a group of workers in the clinical oncology dispensary where all aseptically prepared (in a sterile environment) chemotherapy for both inpatients and outpatients is dispensed.
The chemotherapy is made in a specialist cabinet to keep it sterile as well as to limit the contact between the chemotherapy particles and pharmacy staff.
“We seal everything. Because it’s got to go up into the hospital so if there’s a leak its caught. Everything is labelled with the patient’s name and it’s transported like that,” said Zoe, who estimates that the team dispense between 120 and 150 items per day.
In addition to their daily cleaning regime, every three months the team wash the walls of the sterile environment – and every six months the ceilings get the same treatment. But despite the pressured environment, Zoe takes it all in her stride: “There is such a big chain so without us the patient wouldn’t get it but it’s about the whole chain. I don’t really think about it. I just do my job.”
Next up is the special production unit, which is involved primarily with making total parenteral nutrition (intravenous feeding solutions) for adults, children and neonates, preparation of batches of chemotherapy, and sterile preparation of clinical trial medicines.
Aseptic services trainer Clare Baverstock said: “It looks like a milky substance that is given through the veins for 24 hours to feed the patients while they can’t eat. Each patient has their own requirements, which electrolytes they need, so they decide then whether they want a tailor-made bag specifically for that patient where we make it from scratch or we can use an off-the-shelf bag and just add the electrolytes they need.”
They have the capacity to make feeds for 21 patients, eight of which can be patients who need their feed made up from scratch.
The 14-strong team work to capacity each day, where it takes around two hours for a standard bag to reach the ward and three hours for a tailor-made batch. The majority of the bags have a seven-day expiry but once they are up on the ward – and opened – that must be used withing 24 hours.
And if that wasn’t enough for the pharmacy, its technicians are also based on wards to ensure patients admission medication is checked, that they are supported in administering their medication and offered counselling where needed.
There is no national database which holds the information of what a patient might be receiving.
Ward-based technician Denise Adnett added: “If people don’t know what medications they are on, you have to be a bit of a detective. So, if they come from a care home, you might have to give them a call. If a patient hasn’t brought anything with them and then you might have to call around to find out. Everyone thinks it’s all on a computer.”
And there’s one final area that comes under the running of the pharmacy – the clinical trials unit, which operates receipt and storage of trials, plus organisational support for trials governance, that is safe systems of dispensing and records keeping. The team work closely with both the trust research and development team, national and regional research bodies and the pharmaceutical industry.