Case study: Holly Taylor discusses her role as a Clinical Trials Pharmacist
In Your Path to Research – a series that uncovers the research community across the National Institute for Health Research Clinical Research Network Kent, Surrey and Sussex region – we speak with Holly about the role of a Clinical Trials Pharmacist.
What is your role?
I am the Clinical Trials Pharmacist at Wexham Park Hospital, a role I started in October 2020; after working at Wexham Park Hospital for just over two years as a Clinical Rotational Pharmacist. I was coming to the end of my Clinical Diploma in Pharmacy when I applied for a 10-month secondment as the Clinical Trials Pharmacist. I took the role to see what the job entailed and to explore how I could improve the Clinical Trials Pharmacy service at Wexham Park Hospital. I always thought that if I did not enjoy the role, I could go back to my previous role after the secondment. This was not the case. The 10-months flew by and I felt like I was only just getting started! I then applied for the permanent role and was successful.
At Frimley Park Hospital, there is another Clinical Trials Pharmacist and a Clinical Trials Technician. As we are one Trust, we work closely together as one team, aiming to set up many Clinical Trials of Investigational Medicinal Products (CTIMP) studies across both sites. I am the only pharmacist working in clinical trials at Wexham, therefore I base myself in an office with the main research team, which works really well for collaboration.
I spend approximately one day a week doing paediatric oncology work. I am part of the paediatric oncology multidisciplinary team (MDT) at the hospital, which helps me to keep up with some of my clinical skills. We will be helping to run one of the main paediatric cancer trials, so it is useful for me to know the treatments and what care we usually provide to this patient cohort. The rest of my time involves reviewing new studies, looking at feasibility, set-up, training and managing ongoing dispensing for open trials. Of course there is also lots of documentation to manage, queries, reporting and more recently, working on the introduction of our new Electronic Prescribing and Medicines Administration (EPMA) system which goes ‘live’ in March 2022.
I will soon be undertaking an Independent Prescribing Course, which will enable me to prescribe medications to patients within my competence. I would like to investigate the roles of Independent Prescribing Pharmacists within research in the future. This could potentially lead to me becoming a Principal Investigator for studies within a speciality area.
Why did you become interested in research?
Alongside Chemistry, Mathematics and Geography, I also studied Psychology as one of my A-levels. Looking back, I realise how much attention I paid to the research we were taught about and how it was conducted. I found some of the studies very interesting, such as Charles K. Hofling’s hospital experiment, an obedience study following the infamous Milgram’s shock experiment. I am sure these would never be granted ethics approval nowadays!
To become a pharmacist you have to study for a Master’s degree in Pharmacy (MPharm). At University, you are taught by a variety of academic staff with research expertise. Most lecturers and professors conduct their own research, from drug discovery to clinical practice; exposing undergraduates to multiple research and innovation projects. Towards the end of the degree, you have the opportunity to do your own research project. My final year research project focused on the chemical synthesis and development of a compound that could inhibit an enzyme known as ART1, to help design a new drug with potential to treat metastatic cancers.
When the COVID-19 pandemic began I was working on a stroke ward, but was rapidly trained and redeployed to work on our intensive care unit. During the first wave, I was exposed to research by working on the Randomised Evaluation of COVID-19 Therapy (RECOVERY trial), which was probably one of the first large inpatient clinical trials conducted at Wexham Park Hospital. The Clinical Trials Pharmacist at the time would send out information about which medications were being added to the trial. I found it all fascinating, as at the time, we did not know what would be effective at treating COVID-19. The research nurses and practitioners started to become very familiar, I would see their purple tunics more regularly, it really was this that exposed me to the fact that we conducted research in our hospital!
What do you enjoy about your role?
Working in research can be very rewarding and enjoyable. We all work towards the same goal, ensuring we are able to offer patients at Wexham Park Hospital the opportunity to take part in research. Most patients are very keen to take part in our studies and many are extremely interested to know the results and be kept informed by the sponsors at the end of the study. Some of our patients do not realise that their local general district hospital provides these chances to take part in research. Hopefully our new EMPA system will help our patients engage further.
It is great to see that some of the medications trialled and offered to patients in COVID-19 trials, such as RECOVERY and the Randomized, Embedded, Multifactorial, Adaptive Platform trial for Community-Acquired Pneumonia (REMAP-CAP) were effective, approved and are now being used to treat those admitted with COVID-19. We were able to offer several hundred patients the opportunity to be a part of these trials and have access to these medications, prior to them being approved for use. I am extremely proud that I got the chance to be involved in research at such a pivotal time, helping recruit to these crucial urgent public health studies, many of which are still ongoing.
What challenges do you encounter?
At the beginning, I found working more independently challenging compared to being part of the clinical pharmacy team, working on wards and in the dispensary. I do have my counterpart at Frimley Park Hospital and lots of colleagues in our Research & Development department for advice or help when I need it. I have learnt a lot from some very experienced colleagues, which I am very grateful for.
We also do not have a designated space for dispensing clinical trial medications, so this can be particularly challenging at times. Training is another responsibility which can be a challenge. I must ensure that every pharmacist, pharmacy technician and colleague within pharmacy is aware of the clinical trials we have open and is confident carrying out certain tasks they will be responsible for example screening, ordering, dispensing and checking.
What advice would you give to other pharmacists about going into research?
I think many pharmacists’ perception of working in research is different to the reality. Hospital pharmacists are often used to running around on wards throughout the hospital and in the dispensary, working one day to the next conducting medicine reconciliations and facilitating patient discharge, amongst many other clinical tasks. Working as the Clinical Trials Pharmacist is a shift to working towards study targets set for the next few weeks, months, or even years, requiring a different working style altogether. There are many different tasks to be completed and opportunities to be involved in. It is possible to build relationships and rapport with clinical colleagues who are also involved, such as principal investigators and specialist research nurses.
I advise interested colleagues to look on the NIHR website for more information and to consider completing Good Clinical Practice (GCP) training. This set of quality standards for designing, conducting, recording, and reporting trials will help them to gain an understanding as to how to conduct a clinical trial and the important aspects of managing CTIMPs.
It’s also important to remember that all NHS Trusts will be slightly different in their approach to research, research activity and departmental set up. Occasionally for pharmacists or pharmacy technicians, there are split positions available. For example, a pharmacy technician could work two or three days a week in research with the rest of the week in an aseptic suite or dispensary. It is always worth speaking to a Trusts Research & Development team to see what could be available.
I always remind other healthcare professionals that the clinical guidelines we refer to on a day to day basis are usually a result of good quality clinical trials and studies that have proven the best possible use of medications and treatment options. For as long as we want to be at the forefront of medical science and provide exceptional, evidence-based care, we must continue to support research activity. It may not always feel ground-breaking, however every participant recruited helps to solve a valid research question.