Overview

This session brought together pharmacists and pharmacy technicians to reflect on how different sciences are utilised by pharmacy professionals working across different specialities, and why scientific knowledge is essential to their roles.

Our speakers:

 Nabeel Syed - Clinical Pharmacist, Great Ormond Street Children's Hospital and Locum Community Pharmacist

 Rachel Berry - Chief Pharmaceutical Officer's Clinical Fellow, UKHSA

The two speakers presented on their respective experiences and how the use of science in their practice has changed as their career has progressed.

Our panellists:

Rakhi Aggarwal - Visiting Professorial Fellow,  Aston University;  Head of Medicines Optimisation, Staffordshire & Stoke-on-Trent ICB; Primary Care Lead, NHS SPS

Zoe Kennerley - Consultant Antimicrobial Pharmacist, Betsi Cadwaladr University Health Board

Dawn Ovonlen - Lead Pharmacy Technician, Primary Care

Our panellists comprised RPS Antimicrobial Expert Advisory Group (AmEAG) members and a Pharmacy Technician. They reflected on the speakers' presentations and provided their insights on how they use science in their roles.

Background

Highlighting the importance of science in pharmacy is a priority area for the RPS Science and Research Team, with much of the work being inspired by a past case series project conducted by Professor Diane Ashiru-Oredope. This project brought together the scientific contributions pharmacy professionals made throughout the COVID-19 pandemic on a local, national, and international scale. These cases highlighted select examples of the scientific expertise of pharmacy professionals and provides insight into the impactful work pharmacists and pharmacy technicians were collectively able to do throughout the COVID-19 pandemic because of their science training.

In 2024, the RPS Science & Research Team worked with the RPS Antimicrobials EAG to understand how antimicrobial-specialist pharmacists utilise various sciences in their practice, producing a blog summarising their thoughts. This session followed a similar line of questioning, but focused on a different subgroup of pharmacists.

Nabeel Syed - Application of Science in Paediatric Pharmacy Practice

Social and behavioural science

Nabeel spoke to the importance of tailored communication for the children and patients to ensure the information is appropriate for their age and social, cultural, and educational backgrounds. The use of behavioural change models has been useful to Nabeel’s practice to educate families about complex drug regimens and ensure the desired behaviours are achieved.

Physiology

Paediatric physiology is very different to the physiology of adults, and this needs to be understood when making decisions about their medication. Nabeel stressed the importance of understanding that children aren’t “small adults” and that their organ maturity affects how drugs are processed. One example was the underdevelopment of liver enzymes in premature babies, which would alter the metabolism and excretion of medications. Pharmacokinetic and physiological knowledge allows pharmacists to understand this and find effective solutions.

Pharmacology

Nabeel highlighted that the use of medications in children is more complex, as few drugs are initially developed for children in mind. Additionally, currently, only one-third of adult medications are licensed for use in children. As such, an understanding of pharmacology is essential when using adult medication in children, to allow the careful study and dose adjustments required.

Pharmaceutics/formulations

Age-appropriate formulations are needed to ensure medications can easily be taken by children. Nabeel provided examples from his practice, such as the creation of liquid suspensions, or crushing and dispersing tablets, to make the medication easier to ingest. He also warned of issues pertaining to tube sizes and alcohol content of certain medications, which could be inappropriate for children. As well as adjustments to formulations that make it physically possible or easier for children to ingest medication, Nabeel highlighted the importance of medication taste and appearance to support medication adherence in children.

Pharmacokinetics

Pharmacokinetics and dynamics vary greatly in children depending on their age and development, as such it is essential that this knowledge is utilised in clinical practice when monitoring our patients. Nabeel also warned that methods used to make taking the medicine easier, such as crushing and dispersing, may result in an altered medication Cmax.

Public Health

Protecting child health at a population level is extremely important. Pharmacists are essential to intervention and stewardship programmes, such as vaccination rollouts and antibiotic stewardship. As the medication experts, Nabeel stressed that the role pharmacists can play in making these important public health measures understandable and effective for children is essential.

Are pharmacists Scientists or clinicians?

Rachel Berry - The Use of Science in Antimicrobial Pharmacy Practice

Rachel began her presentation by providing an overview of her career, which has involved many roles in clinical settings, local trusts, and now in a national agency role. She reflected that she has used science throughout all her roles, but has leaned on different areas of scientific knowledge and understanding as she’s moved into different roles. For example, when reviewing patients and in operational areas of pharmacy, such as the aseptic unit, it was essential to understand how a drug gets in and out of a human body and the impact it has when it is there. This understanding ensures that patients get the correct drug in the correct way without experiencing any preventable side effects.

Rachel focused her presentation on how science has influenced her antimicrobial stewardship practice at a patient-level vs. a national-level.

Patient facing

When working with patients, it is essential that the pharmacist works to get them the right medicine at the right dose, strength, and frequency to fight an infection.

Rachel provided some examples, highlighting how microbiology and pharmacology are essential for identifying the correct drug for a patient:

• Molecular biology – Understanding what the likely causative organisms are and whether they are gram-negative or gram-positive
• Pharmacology - What antibiotic would provide an adequate spectrum of cover?

Other sciences, such as pharmacokinetics, formulations, and physiology, are essential for identifying the correct route for drug delivery:

• Pharmacokinetics - Can the drug get into the body at the correct levels?
• Formulations - Will it get to where the infection is at appropriate levels?
• Physiology - How do patient factors impact this?

Considering patient-specific factors, such as allergy status and co-morbidities, also requires scientific expertise to understand why certain medications should/shouldn’t be used, ensuring every patient receives the most appropriate care for them.

• Chemistry – Will an antibiotic have cross-reactivity with a patient? The chemical structure is what can define allergy status
• Pharmacokinetics – Liver impairment may impact how medication is metabolised

Non-patient facing

In a previous role, Rachel worked in a large sub-ICB in the North East and North Cumbria ICB with a population of around 600,000. This population was spread over a wide area and was extremely varied – with areas of rurality, historic mining and heavy industry areas. The health literacy for the region is 6 years of age, and there were extremely high areas of co-morbidity and deprivation. All these factors contributed to the area having one of the highest levels of antibiotic prescribing in the UK. Rachel and her team wanted to expand regional understanding of appropriate antibiotic usage, and why this was so important. The use of behavioral science frameworks was essential to tackling this challenge.

Updates to the NICE 91 Guidance on Antimicrobial Treatment of Acute Otitis Media in March 2022 included a non-antibiotic treatment option - Otigo® ear drops. This gave Rachel an opportunity to target a subset of the patient population and ensure appropriate use of antibiotics. This route also supported prescribers as it offered parents a treatment option for their child without resorting to antibiotics, ensuring parental satisfaction.

The COM-B model of behavioural change was used to approach this project

• CAPABILITY is defined as the individual’s psychological and physical capability to engage in the activity concerned
• OPPORTUNITY refers to the external factors which make the execution of a particular behaviour possible.
• MOTIVATION refers to the internal processes that influence decision making and behaviour

In this project, COM-B in action looked like:

This behavioural science project resulted in County Durham being amongst the highest prescribers of Otigo® in the country, with antibiotic prescription numbers concurrently declining. Given the project's success, the interventions were rolled out further across the ICB.

Rachel concluded by highlighting that sciences have been essential to her pharmacy career, in both patient-facing and national-level roles. Scientific principles are at the core of pharmacy decision-making.

Panel Discussion

Rakhi

Thinking about her career, Rakhi shared that she wouldn’t have thought of herself as a scientist before the presentations, but now realises that she uses science every day. From looking at drug stability and storage, considering alternative medications in cases of medication shortages, and developing guidance on how to implement practice changes, science has been at the foundation of all her decision-making.

Dawn

Dawn shared that, as a hospital pharmacy technician, science is fundamental to her role. She provided the treatment of malnourished newborns, and how their physiological test results were essential to understanding how to appropriately adjust their nutrition. Dawn also reflected on her time working in primary care, during which she went beyond the designated task to investigate suspected asthma in patients and analysed eosinophil levels from full blood count (FBC) testing to confirm or rule out the diagnosis. Understanding how and why this test was necessary would not have been possible without her scientific expertise.

Zoe

As the Chair of the Welsh antimicrobial pharmacy group, Zoe reflected that, when producing guidelines, the group collaboratively assesses the available evidence, utilising their knowledge of pharmacokinetics and pharmacodynamics to make decision. Even in a non-patient-facing role, these sciences are essential. She has also frequently used behavioural science to implement and evaluate the changes set out in the guidelines, to improve understanding of patient behaviours, and barriers to appropriate care. Zoe reflected that, although many people, including herself, may not instantly think of themselves as scientists, once you delve a bit deeper and consider what your role looks like on a day-to-day basis, you’ll see that you utilise scientific principles and knowledge far more than you think. Science is embedded in pharmacy careers, as it is embedded in the MPharm degree.

Read about our other presentations at the 2025 Clinical Pharmacy Congress below: