Clinical Practice & Medication Use
- Research group overview
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This group integrates clinical practice and medication-related research activity across King\'s Health Partners, namely King\'s College London and the local NHS Foundation Trusts, Guy\'s and St Thomas\', King\'s College Hospital, and South London and Maudsley. The group consists of both academic staff based at King\'s College London and clinical academics in the Trusts. In addition, the three local partner trusts employ seven consultant pharmacists (Medication Safety, Paediatrics, Critical Care, Infectious Diseases, Cardiology & Elderly Care) and six senior pharmacists who undertake research as part of their job profile.
The expertise and main research activity of the group embraces two key areas:
I. Medication Use Research
a. Information about medicines and adherence: this work is led by Professor Graham Davies and Duncan McRobbie and includes collaborations with the Department of Psychology (Professor Weinman, Institute of Psychiatry at King\'s College London), the Centre for Behavioural Medicines (Professor Horne, London School of Pharmacy) and the Centre for the Study of Incentives in Health (Professor Marteau, Institute of Psychiatry at King\'s College London). This work investigates the relationship between the information patients receive about their medicines and how they are used. This work will lead to the design and evaluation of more effective medicines support systems to improve informed patient adherence to their prescribed medicines.
b. Medication Safety: this work is conducted by Dr Cate Whittlesea in collaboration with Consultant Pharmacists Gillian Cavell (King\'s College Hospital NHS Foundation Trust) and Alice Oborne (Guy\'s & St Thomas NHS Foundation Trust). This work focuses on detecting and reporting medication safety incidents in order to design, implement and evaluate a range of interventions to reduce risk. The group is currently collaborating on patient safety initiatives with colleagues at St James\'s Hospital and Trinity College Dublin on safety culture.
II. Clinical Research
a. Mental Health: this work is led by Professor David Taylor in collaboration with colleagues from the South London and Maudsley NHS Foundation Trust (Attard, Bishara, Connolly & Mace) and the Institute of Psychiatry (Kapur and Patel) to explore the use of anti-psychotic and anti-depressant medicines in order to understand the influence of a range of factors on their clinical use. An important strand of this work are the studies of the efficacy and safety of newer agents recently introduced to the market.rn
b. Critical Care: this work, led by Dr Catherine McKenzie (Consultant Pharmacist, Critical Care, Guy\'s and St Thomas\' NHS Foundation Trust) in collaboration with Professor Davies, Dr Beale and Dr Terblanche (Consultant Intensivists, Intensive Care Unit, Guy\'s and St Thomas\' NHS Foundation Trust), focuses on medicines use (mainly sedatives and antibiotics) in patients with sepsis and severe sepsis.
c. Work supported by the Biomedical Research Centre under the supervision of Professor Davies evaluates the pharmacokinetic and pharmacodynamic properties of a low molecular weight heparin when prescribed during pregnancy. This project involves the collaboration with Dr Arya (Department of Haematology, King\'s College Hospital).
This two year study will utilise and enhance the existing skills of community pharmacists, who will conduct brief alcohol interventions in their pharmacies to determine the feasibility and effectiveness of this intervention in reducing and preventing harm from alcohol misuse.
A further study in collaboration with Karen Rosenbloom and Hertfordshire LPC is developing a needs assessment to determine the pharmaceutical public health needs of people living and working in Hertfordshire.
It is anticipated that following evaluation of the results from this assessment further research will develop, implement and evaluate a public health intervention developed in the community pharmacy setting
In collaboration with colleagues in NHS hospital Trusts in Wales, Guys and St Thomas’s, King’s College Hospital, Foundation Trusts in London and the Department of Management King’s College London, Dr Whittlesea leads research into medicines safety with a special interest risk reduction strategies in the medication use process.
Published research focuses on dispensing including identification of the common dispensing incident types, such as supply of the incorrect drug, wrong strength / quantity, and labelling medication with the wrong directions.
Dispensing incidents, if undetected, can cause serious patient harm research focuses on the causes of dispensing incidents including look alike, sound alike drugs; high workload, low staffing, interruptions and job dissatisfaction.
Current studies include impact of automated dispensing systems on workload, pharmacy staff stressors and dispensing incidents in hospital pharmacy. This research has been funded by a number of grants from the National Assembly, Wales.
In collaboration with colleagues in the Florence Nightingale School of Nursing & Midwifery London and health economists at the Institute of Psychiatry King’s College London, Dr Whittlesea completed a Department of Health funded study to investigate the ‘Perceptions and effectiveness of Supplementary prescribing in mental health’.
This study was undertaken to assess the impact and effectiveness of supplementary prescribing by mental health nurses on NHS care delivery and evaluate staff, service and user outcomes.
- Mental health
- Clinical trials
- Naturalistic follow-up studies
- Pharmacoeconomics
The research undertaken by Professor Davies represents two key themes – clinical and educational research.
The clinical research programme focuses on the critically ill and addresses problems experienced in the day to day clinical environment. For example, research investigating the use of midazolam (a sedative) on the intensive care unit, Guy's and St Thomas' NHS Foundation Trust, led to a change in prescribing policy, an achievement recognised nationally (UKCPA Advanced Practice Award 2006).
Other work, also undertaken at Guy's and St Thomas', evaluated the effectivness of clonidine, when given orally, as a sedative for children on the paediatric intensive care unit. Professor Davies has also studied the clearance of a number of drugs (morphine, quinine and cifpirome) by continuous renal replacements, to provide dosing guidance for prescribers.
The educational research programme focuses on the design and testing of pharmacist development frameworks as a direct response to the Clinical Governance agenda within the NHS, thereby improving the safe and effective use of medicines. Professor Davies is a founder member of the Competency Development and Evaluation Group (CoDEG, http://www.codeg.org) a collaborative network of specialist NHS practitioners and academics drawn from the two London Schools of Pharmacy.
These frameworks have been formally recognized by the Department of Health, in the policy document "Guidance for the Development of Consultant Pharmacist Posts" (DH March 2005) and have international application as demonstrated by their formal adoption in Australia to deliver recommendations outlined in the Australian Pharmaceutical Advisory Council (APAC) principles and Society of Hospital Pharmacists of Australia (SHPA) Standards of Practice for Clinical Pharmacy.
This research has directly led to a fundamental reform of postregistration pharmacist education which has seen the establishment of a collaborative between 6 Schools of Pharmacy (Brighton, East Anglia, London {2 Schools}, Portsmouth & Medway) and the National Health Service (www.postgraduatepharmacy.org ).
This initiative has been supported by a £1.3 million grant (Lead centre, University of London) secured from the Strategic Development Fund (HEFCE) in January 2007.
Development of Cultural Awareness and Sensitivity amongst Healthcare
Professionals, academic staff and students to enhance patient-centred care
sing the techniques of Motivational Interviewing (MI) to enhance student learning
Developing a portfolio-based approach to encourage continuing professional development (CPD) in undergraduate pharmacy students
Using a 'communities of practice' approach to coaching and mentoring community pharmacists in developing their CPD
Developing evaluation methods for curriculum review
Developing educational and practice supervisors (DEPS) in the pharmacy workplace
Using peer-assessment as a tool to promote student learning and reduce the burden of summative assessment
