A Pharmacist Amongst Paramedics: My experience with the National Ambulance Service Clinical Directorate

Written by Edel Burton – Edel Burton is a second year Structured Population and Health-services Research Education (SPHeRE) scholar in University College Cork and a scholar on the Health Research Board(HRB) Collaborative Doctoral Programme in Chronic Disease Prevention(CDP- CDP).

Edel is also a Clinical Pharmacist in the Bons Secours Hospital Cork.

As part of her PhD studies Edel carried out a placement in the National Ambulance Service (NAS) Clinical Directorate, in Dooradoyle, Limerick from March to May 2022. Edel’s placement supervisor was Mr. David Willis, Clinical Information Manager with NAS.

BACKGROUND

We have all been told multiple times that a PhD is a marathon and not a sprint. If we are sticking with that analogy, my placement with NAS was like winning the gold medal. This opportunity allowed me to engage with a multidisciplinary team of prehospital care professionals, familiarise myself with the clinical data collected by NAS and become part of this dynamic empathetic team providing patient-centred care.

Due to the developing and ever-expanding area of pre-hospital care I believe it is an exciting time for me to become involved with the ambulance service. From my clinical and research experience I have a clear understanding of medications, and protocols related to pre-hospital care and the importance of thorough handover between pre-hospital and acute care. The value of high-quality, well-placed and rigorous clinical pre-hospital research and clinical practice initiatives is very clear across my roles on a daily basis. Thus, as a pre-hospital care researcher and a practising pharmacist this opportunity allowed me to reflect on my research, my role as a pharmacist and continue to engage with stakeholders, procedures and practices in pre-hospital care.

REFLECTION – USING GIBBS REFLECTIVE CYCLE 1988

1. Description

The team in the Clinical Directorate consists of a multidisciplinary group including the Clinical Director, The Clinical Information Manager, The Clinical Development Manager, The Covid – 19 and Winter Lead, Data Analysts, The PA to the Clinical Director and Audit Support staff.

During my time on placement, I primarily worked on two reports. Firstly, in relation to optimising the process of exporting a medication list into the electronic patient care record used by ambulance staff. Secondly, I also worked on a medication safety report which consisted of auditing the use of controlled drugs over a yearly period.

Mornings usually consisted of data entry or report composition. After that, the afternoon could look different every day. Sometimes I might be asked to pharmaceutically analyse a report or offer an insight into a clinical/ research query. Everyday my supervisor would ensure we had a meeting to discuss the progress of my assigned tasks, ask any questions and work through any PhD-related queries. Outside of this time I would be analysing data or reviewing resources to include in my assigned reports.

2. Feeling

Before I started my time with the ambulance service I was intrigued to learn more about their organisational structure, medication management strategies, team dynamic, protocols and procedures. I was eager to deepen my understanding of pre-hospital care and felt energized by the opportunity to immerse myself in this environment.

During my time in the Clinical Directorate, I felt that my comprehension and appreciation for integration across not only healthcare professions but also healthcare sectors deepened. Written on the wall of the office of the Clinical Directorate is “ to serve the needs of patients and the public as part of an integrated health system through the provision of high quality, safe and patient centred ambulance services”. I believe that holistic and robust healthcare delivery is built on teamwork.

Different disciplines working together to deliver evidence-based care. Thus, every day I observed that statement on the wall and witnessed its principle in action I felt proud to be associated with this team. This statement also challenged me to continue to embody this statement in my own work and reflect on my own practices.

Furthermore, after the placement I now feel that from both a research and clinical perspective my perception of holistic care has greatly developed. This learning was facilitated by a dynamic team and familiarisation with ambulance service data. As my PhD work is focusing on pre-hospital care, I am delighted that members of National Ambulance Service will be involved throughout my studies. I strongly believe that my placement with the Clinical Directorate facilitated this collaboration, as it gave me the opportunity to understand the National Ambulance Service processes and environment. Consequently, I am motivated to continue my engagement and relationship with the service.

3. Evaluation

I can honestly say that all aspects of my experience with NAS were positive. In particular the continued training and immersion in the pre-hospital culture I received by all members of the team. I was given the chance early on in the placement to review Pre-hospital Emergency Care Council Guidelines, Health Information and Quality Authority standards, and other documents related to pre-hospital care. Due to my background, I was particularly interested in the medication related aspects of the documents. I was very engaged by the regulations surrounding the medications which an emergency medical technician, paramedic and an advanced paramedic can administer. The dosages and routes of administration included in the guidelines also caused me to reflect on the clinical significance of these aspects and their application.

Due to both my research and clinical background I also appreciated the opportunity to engage with the electronic platform operated by NAS. The method in which the current medications prescribed to the patient were captured and how these were handed over to those in acute care piqued my interest. I reflected on how the process of importing a validated medication list into this electronic platform could be optimised. This became one of the main bodies of work I completed during my time with NAS.

As a result of the relationship I have developed with the Clinical Directorate team and the synergism between the service and my work NAS became involved in a recent international multidisciplinary event. The Collaborative Doctoral Programme in Chronic Disease Prevention annual Summer School was hosted in Galway on 14-15th June this year, facilitating shared discussion between national and international experts on chronic disease prevention. Mr. David Willis (Clinical Information Manager in NAS) was invited to speak about “National Ambulance Service – Ireland, Deployment of Pre-Hospital EHR” in the “Digital transformation: Irish trailblazers” session.

This event was a milestone for me, not only in my PhD journey but also in my clinical career. I believe my research helped to forge a link between pre-hospital care and researchers to optimise patient care and shared learning. I think the event was a great success in many ways, due to knowledge translation and informed critical discussion. Furthermore, David’s presentation and discussion allowed me to further develop my appreciation of the pre-hospital care environment and the role of all healthcare professionals in this sector. Additionally, I was left looking towards the future in terms of lessons learned and potential quality improvements initiatives.

4. Analysis

For me the most meaningful aspect of this experience was appreciating the value of true stakeholder involvement in research. Previously my knowledge of the pre-hospital phase of care was limited to my practice in acute care and clinical research. As a result of engaging with NAS and involving at least one member of the team in each of my studies I have significantly improved my understanding of this environment. Having experienced the working environment of the Clinical Directorate I now know the finer detail of pre-hospital care practice. I also have gained further insight into the nature and scope of data captured by the service and its application in research and quality improvement.

Additionally, I really appreciated that the team valued my skills and experience as both a pharmacist and clinical researcher. On reflection, I can see that this was a key facilitator for the success of the placement and a foundation for my future relationship with the team. At first, I did not know exactly how my skills and expertise would fit into the daily operations of the Clinical Directorate. However, as the placement continued, I began to notice how my portfolio and experience were complementary to that of other team members. Once we spoke the same general language of patient centred care, the mix of different disciplines, experience and perspectives enriched experiences and resulted in positive outcomes.

I can now see that the Summer School and co-authorship on PhD publications with members of the NAS team were only tangible examples of the mutualistic and collegial relationship we had built. I contend that the collegiately, mutual respect and appreciation for transdisciplinary working that underpin these outcomes displayed the true value of the relationship. In my opinion this started with the immersive experience of placement, however continued mutual respect and shared interest allows the collaboration to flourish.

5. Conclusion

In retrospect I believe my professional skills have developed in many regards. As I was tasked with composing reports I needed to understand how to present pharmaceutical information to a multidisciplinary audience. At first I found it daunting to write a report for use within NAS on a typically pharmaceutical area. In hindsight I can see that the apprehension was not required, and that I should have seen the opportunity as a chance to further develop my presentation and communication skills. The willingness of the team to engage with me and unpick the details of the report to ensure a useful and accessible document ensured a serviceable and constructive report.

In terms of technical skills, I was immersed in the datasets used by NAS, particularly those related to medications and clinical presentation. Initially, I questioned my ability to navigate and analyse these datasets due to their level of detail and volume. However, I have significantly improved my ability to analyse vast datasets due to working with members of the NAS team.

I can now see that maybe due to my clinical discipline and professional experience that I learn by engaging in an activity and learning with and from my colleagues. Having applied my learning by working with the data I could understand its origin and day-to-day use. As a result, I could clinically appreciate the information gathered. Furthermore, as I am using similar data for my research, I could now analyse the data with more confidence and agility.

6. Action Plan

I am very fortunate that my relationship with the Clinical Directorate continues and that I am considered part of the team. Working with the Clinical Directorate is a privilege, and I am grateful to all the team, my supervisors and SPHeRE for granting me this opportunity.

Going forward I hope to gain further hands-on experience with the electronic environment of the ambulance service by attending training sessions. I believe this will provide me with the skills to critically analyse the NAS dataset and also understand the value of this dataset in other areas of the health service.

Also, I can now see that pharmacists can have a significant role in pre-hospital care. Research such as Beatrous et al. 2021 highlights a pharmacist’s role in helping to drive patient safety and well-being in this sector. As a pharmacist, I welcome any opportunity to advocate for pre-hospital care in any of its forms, both from a clinical and research perspective.

CONCLUSION

I can say with true confidence that this opportunity has challenged me to further explore the execution of integrated care and research. I truly believe that my work with NAS has not only vastly improved the potential value of my research but also optimised my ability to provide holistic patient care. I am delighted that I did not need to say goodbye to the NAS team after placement. As I learned from my NAS colleagues; “Never Say Goodbye, Always Say Good Luck”

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