Reena Mehta, a consultant pharmacist in critical care at King’s College Hospital, London, UK, has become the first pharmacist appointed as chair of the Intensive Care Society’s Learning division. She talks to Katherine Price about bringing a different perspective to the role, ensuring diverse and multidisciplinary education opportunities for the critical care community in order to deliver the highest quality of care to the sickest of patients in hospitals.
It was the variety of the sector that attracted Reena Mehta to pharmacy, and the team dynamic that led her to settle within the hospital environment. Invited to train as a critical care pharmacist, which at the time there weren’t many of at King’s College Hospital in London, it turned out to be an ideal fit.
‘Within weeks, I found my love for critical care and passion of watching patients recover from being incredibly sick,’ she explains. ‘There are lots of challenges and lots of rewards as well, and you can use your expertise as a pharmacist to think outside the box in a different way around medicines safety and optimising therapy.’
When she started working in critical care at King’s in 2007, it had 32 beds across two intensive care units (ICUs), two pharmacists and a paper-based system. It’s now grown to have 107 beds, a team of 10 pharmacy staff and digital systems.
Reena was promoted to a newly created post as a consultant pharmacist in critical care in 2020 – one of just 10 in the UK. It’s a varied role, she explains, with clinical responsibilities centred around supporting her team and service with complex queries, as well as strategic thinking around delivery of an effective pharmacy service to critically ill patients.
She also has a key role in research, including being a principal investigator on several NIHR Clinical Research Network portfolio studies and supporting colleagues – ‘not just pharmacists, but medical and nursing staff as well’, she clarifies. The role also extends to working collaboratively with local and national stakeholders and acting as a role model, providing specialist input and expert advice in critical care.
Having been a pharmacy representative with the Intensive Care Society since 2019, and chair of its Pharmacy Professional Advisory Group (PAG) for the last three years, despite some apprehension, she put herself forward for chair of the Learning division when the position became vacant earlier this year. She was subsequently elected the first non-medical chair for the Learning division and education committee in the society’s 54-year history.
A different perspective to critical care
Reena’s remit includes exploring new training opportunities for the multidisciplinary intensive care community, including organising content for study days. She has already reached out to members for feedback on how these days are run, what they want to see and what could be done differently as study budgets get tighter for attendees.
Her priority is making these events as engaging as possible for a multiprofessional audience and she is keen to work on more collaborative study days with other professional bodies. ‘Critical care is a team sport,’ she explains. ‘Each day you’ll go on ward rounds as part of a multidisciplinary team, so it’s important you work with them inside the four walls, as well as outside.’
Reena is also charged with exploring course accreditation opportunities and chairing the Intensive Care Society’s education committee, ensuring voices from across the intensive care field are heard. And while she may have initially felt like a bit of an outsider, she’s already noticing what her pharmacy perspective can offer by asking diverse questions and proposing different topics and speakers for study days.
‘You have that feeling that everything you know, others will know. You don’t realise what potential you have and what you can give until you work outside your boundary,’ she says.
Thinking outside of the pharmacy box
The Intensive Care Society role is also benefiting Reena professionally, making her think outside of the pharmacy box, establish new relationships and networks, and push herself beyond her comfort zone. ‘And at the end of the day, all of this is to provide critically ill patients the best and optimal care. It’s being able to reach out further than the four walls that you work within all the time,’ she says.
Reena’s term as the chair of the Learning division will depend on whether she is re-elected to the Intensive Care Society council or continues to act as chair of the pharmacy PAG. Longer-term, she is keen to work closely with the Intensive Care Society and, if opportunities arise, to work towards applying for a role on the Trustee Board, ‘because, again, they’ve never had a pharmacist and we bring a different perspective due to our training and skill set’, she says.
Balancing these external leadership roles with her clinical work is a top priority for Reena as being a critical care pharmacist remains her passion. ‘I need to ensure all my other roles are worked around my clinical commitment to the patients. At the end, it all comes down to patient care, it’s what we’re there to do,’ she says. ‘I’m still a clinical pharmacist, that’s one thing I don’t want to lose.’
Challenges and opportunities in critical care
Since the Covid-19 pandemic, shortages of critical care beds in the UK are high on the national agenda, and Reena is in the process of publishing a paper reviewing the geographical disparities in adult intensive care beds per capita in the NHS in England as part of her recently completed MSc in Health Economics, Policy and Management at the London School of Economics and Political Science.
Medicines shortages, meanwhile, are ‘probably going to get worse before they get better’, she says, and this is an issue the Intensive Care Society is ‘very aware’ of and is exploring ways to support hospitals, especially smaller hospitals where fewer resources are available. ‘This is adding a lot of pressure on pharmacy staff to source alternatives and we need the Government to help stabilise the situation,’ she says.
Reena also sees opportunities in patient rehabilitation post-critical illness, such as addressing inappropriate medicines continuation and discontinuation. To address such challenges will require a well-resourced, well-trained workforce, and Reena was involved in the NHS Adult Critical Care Pharmacy Workforce Strategy, part of which, she says, was highlighting the importance of the whole critical care pharmacy team and utilising each skill set efficiently.
‘Within the ICU, having the correct skill mix among the workforce will help release nursing time. We need nurses to spend their time at the bedside, having direct patient contact and not putting drugs away, emptying bed pans, ordering medication, et cetera,’ Reena explains. She also emphasises that there are ‘many roles within the pharmacy workforce’ that can support with the shortage of nurses being seen in the UK and elsewhere in Europe.
As for training, the Royal Pharmaceutical Society and UK Clinical Pharmacy Association have published an advanced pharmacist critical care curriculum. And, since April, NHS England is funding training places for pharmacy staff working in adult critical care units. This is something that Reena says will transform patient care for the better.
‘A hundred pharmacists in the country are now enrolled on this first course, which means we will get pharmacists in a year’s time coming out that will all be pretty much trained up to the same level, which is so important, because a big problem we have in critical care pharmacy is a lack of standardised training,’ says Reena. ‘[It’s] making sure we’re able to train the workforce to a certain level so that every patient gets the same care in whichever ICU they are admitted to.’
