Flu vaccination by pharmacists leads to suboptimal medical recordsBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5084 (Published 09 November 2017) Cite this as: BMJ 2017;359:j5084
All rapid responses
I hear de Lusignan et al calling pharmacist-to-physician communication "suboptimal."<1> But I wonder whether anyone thinks physician-to-pharmacist communication is any better. How many prescriptions from physicians include ample details about the indications and management plans? Without this information, pharmacists cannot fully utilise their abilities to identity drug-therapy problems, such as using drugs with inappropriate indications and doses, and suggest alternatives.<2> How are pharmacists supposed to monitor patients' therapies when this information is not readily available?
As Buxton correctly stated, pharmacies retain information about manufacturers and batch numbers of vaccines, which are available upon physicians' requests.<3> Many pharmacists are keen to communicate and work together with physicians, and file a Yellow Card report for suspected adverse drug reactions. In comparison, would all physicians welcome pharmacists with open arms, when receiving inquiries about laboratory and clinical findings?<4><5> Would physicians ensure all their prescriptions have the required electronic coding for pharmacy auditing?
It is disappointing to hear pushbacks on pharmacist involvement in patient care such as influenza vaccination,<6> and simultaneously scepticism about pharmacists’ ability to reduce GPs’ workload.<7> Concerns about physicians’ fatigue are looming,<8> but many are resistant to empower and collaborate with other healthcare professionals. In many NHS institutions, physicians could simply hear “I don’t know how to do it” when trying to delegate jobs, such as venepuncture and cannulation, to other professionals. Why not make use of the ones who want to expand their scope of practice, so that physicians can focus more on complex patient cases?
If we, physicians and pharmacists alike, want to improve communication with each other, we should start with the men and women in the mirror. Those who live in glass houses should not throw stones.
1. de Lusignan S, Hoghton M, Rafi I. Flu vaccination by pharmacists leads to suboptimal medical records. BMJ. 2017;359:j5084.
2. Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-Related Problems: Their Structure and Function. DICP. 1990;24(11):1093-1097.
3. Buxton A. Re: Flu vaccination by pharmacists leads to suboptimal medical records. London, UK: BMJ; 2017 Nov 27; cited [Dec 13, 2017]. Available from: http://www.bmj.com/content/359/bmj.j5084/rr.
4. Yeung EYH. Explaining the role of pharmacists in multidisciplinary care. Br J Gen Pract. 2017;67(663):447-448.
5. Yeung EYH. Pharmacists are not physician assistants. Br J Gen Pract. 2017;67(665):548-548.
6. Iacobucci G. General practice threatens to withhold repeat prescriptions until patients have flu vaccine. BMJ. 2017;359:j4682.
7. Avery AJ. Pharmacists working in general practice: can they help tackle the current workload crisis? Br J Gen Pract. 2017;67(662):390-391.
8. Greig P, Snow R. Fatigue and risk: are train drivers safer than doctors? BMJ. 2017;359:j5107.
Competing interests: I have received salaries from working as a physician and pharmacist, but neither of them pays me to write this letter.
I agree with Professor de Lusignan and colleagues that notifications of flu vaccinations administered by community pharmacists would be better sent as coded information, in the way for example that blood test results are transferred into general practice systems. The community pharmacy clinical record system providers, which support the provision of the NHS Community Pharmacy Seasonal Influenza Vaccination Advanced Service, are working with NHS Digital to allow this approach to data transfer in future years.
Professor de Lusignan and colleagues state that there are no recommended codes on the notifications sent from community pharmacies to ensure consistency of coding; this is incorrect. Since the commissioning of the service in 2015, pharmacies providing the service have been required to use the nationally approved form for communicating with general practices. This form includes the SNOMED CT and other legacy clinical terms for “Seasonal influenza vaccination given by pharmacist” alongside a recommendation that the practice uses the relevant clinical term to make an appropriate record for the patient.
Professor de Lusignan and colleagues also note that the form does not include information about the manufacturer and batch number of the vaccine. This is correct, as Public Health England have advised that the patient’s general practice do not routinely need this information to be able to record the administration of the vaccine at the pharmacy. The community pharmacy will however retain this information in their clinical records, so should a general practitioner require batch details in relation to a suspected adverse reaction to a vaccine, this information could be requested from the pharmacy. Should a patient report a suspected adverse reaction to a vaccination to the community pharmacy, a Yellow Card report is likely to be submitted, particularly in the case of black triangle vaccines.
Director of NHS Services
Pharmaceutical Services Negotiating Committee
Competing interests: No competing interests