What is your role?
I am Lead Clinical Trials Pharmacist for the Cardiff and Vale University Health Board. I am based in the Pharmacy Department at University Hospital of Wales, Cardiff.
What first inspired you to become a pharmacist?
I come from a very medical family: my mum was a nurse, my older sister is an immunologist, my younger brother a surgeon, and my dad was an anaesthetist at Papworth Hospital and was involved in the world’s first heart, lung and liver transplants. So I practically grew up around hospitals! Just after my O Levels, I was inspired by the work of Elizabeth Bligh, Chief Pharmacist at Papworth and a pioneer in ward-based clinical pharmacy. This led to me doing a summer job in a pharmacy, after which I knew I’d found what I wanted to do.
My career in pharmacy has involved a number of different roles so far, including Specialist Pharmacist in Clinical Nutrition for Great Ormond Street Hospital for Children in London; and Clinical Pharmacy Lecturer at Otago University, Dunedin, New Zealand. I’ve been at Cardiff and Vale University Health Board since 2005.
What do your day-to-day duties involve?
At any one time, there are around 130 different clinical trials of medicinal products taking place at our hospital, covering all types of diseases. We are only a small group in the pharmacy clinical trials team – just three pharmacists and three technicians – so there are a lot of investigational medicinal products for us to manage. It’s our responsibility to make sure these are correctly received, stored and administered, according to the trial protocol. We work closely with the investigators to make sure we have the correct facilities in place before the trial starts, and write dispensing guidelines for the pharmacy team who issue the treatments to the trial participants.
What happened when COVID-19 first arrived in the UK?
It was a very anxious time, because we knew so little about the disease then and didn’t have any effective treatments to offer patients. So when we were sent the RECOVERY Trial protocol on 16 March, we knew it was a brilliant opportunity to generate conclusive evidence on which treatments worked against COVID-19 and which didn’t. We couldn’t see any reason to delay: across the world, huge numbers of people were dying and the sooner we had proven treatments, the better. Also, the trial was starting with drugs that were already used to treat other
Some of the drug treatments used in the RECOVERY Trial. (Cambridge University Hospitals) conditions and known to be safe. So as soon as we had completed all the checks, we began recruiting participants to RECOVERY, just two days after first hearing about the study.
What were the key challenges caused by the pandemic and how did you adapt?
Before the first wave hit, we didn’t know what to expect so we had to prepare for a scenario where significant numbers of staff were off work with COVID-19. All of us found ourselves rapidly learning new roles, and we wrote many guidelines so that treatments could still be dispensed by other staff members even if our whole team couldn’t come into work. We also had the challenges of working out new infection-control strategies, learning to do everything while wearing PPE, and adapting normally face-to-face activities to virtual formats.
There was also the question of the clinical trials we were already running before the pandemic hit. Because the participants of these studies were now unable to come to the hospital to collect their treatments, our health board rapidly set up a system where volunteers delivered prescriptions to the participants’ homes, and introduced checks to make sure they were received. This meant that most of our non-COVID trials could continue without major disruptions. In fact, I can see direct delivery of clinical trial treatments to patients’ homes where possible being a long-term change, since it means we can recruit participants over a much larger area.
What did you do specifically to support the RECOVERY Trial?
Unlike most clinical trials, which are run through the hospital outpatient clinics, RECOVERY is taking place on the wards and recruiting inpatients. Consequently, when the study first launched, many ward-based staff were suddenly involved in clinical trial research for the first time. We realised that the ward-based pharmacists had a particularly crucial role, both in recruiting participants (for instance, ensuring they weren’t already on medications that interacted with the study treatments) and making sure the treatments were administered correctly. So we worked very closely with them, listening to their concerns and developing thorough guidance notes so they were absolutely confident in their role.
We also wanted to make sure that the RECOVERY Trial treatments could still be administered even if COVID-19 caused any disruptions in the main pharmacy clinical trials team. So we collectively decided to provide whole boxes of the low-cost RECOVERY Trial treatments to the wards, to ensure they always had a readily available stock. This had the added benefit that ward staff could recruit patients to RECOVERY and start administering their treatments at all hours, including weekends when the pharmacy closes for certain periods.
Because Cardiff was one of the first sites in Wales to launch the RECOVERY Trial, we were proactive in sharing the procedures and guidelines we had developed with other hospital teams, some of whom adapted them for their own sites.
Perhaps one positive thing about the pandemic is that it has caused us to work much more collaboratively and share information in new ways, for instance through a new MS Teams Channel for Welsh clinical trial pharmacists.
What have been your highlights from the RECOVERY Trial?
Ultimately, the best thing has been to see the results from RECOVERY lead to better care of patients and improved outcomes. It was incredibly scary in the early days of the pandemic, when we had no proven treatments for COVID-19 and many more people died from the disease. To have contributed in some small way to the better situation now feels very satisfying.
The Cardiff and Vale University Health Board pharmacy clinical trials team also received the Health and Care Research Wales Support and Delivery Impact Awards ‘Outstanding Research Team Award’ for 2020-21. It was a total surprise, because the research delivery nurses nominated us. It was a wonderful honour, but really it was a whole-site team effort and I felt they ought to have been recognised too. I’d also like to thank the central RECOVERY Trial team, particularly Professor Richard Haynes, for being incredibly helpful and supportive throughout, and responding really quickly to our questions.
What lessons from RECOVERY do you hope will be carried forward into the future?
RECOVERY has demonstrated that it is possible to launch a clinical trial quickly without compromising patient safety. It would be good if this led to approval and set-up processes being more streamlined in future. I also hope the improved collaboration between hospital sites will continue, as it has been enormously beneficial to share information and learn how other teams have adapted.
In addition, the trial has reignited a lot of interest from ward-based medical staff in clinical trial research, with many saying they want to be more involved with this in the future. I hope this will continue as it offers exciting possibilities for research, even if it will mean more work for pharmacists!