AWARD WINNER
“SINCE SEPTEMBER 2013, THE CLINICAL PHARMACY TEAM HAS COMPLETELY CHANGED THE WAY THAT THE CLINICAL PHARMACY SERVICE IS DELIVERED, TO ENSURE THAT THE RISK ASSOCIATED WITH MEDICATION ERRORS ARE
REDUCED, AND TO REALISE A MORE PERSON-CENTRED SERVICE, IN LINE WITH PRESCRIPTION FOR EXCELLENCE.”
thing each morning to review the number and location of new patients, both emergency and elective. Team members are routinely allocated to cover the acute medical and surgical admission units and the Intensive Care Unit, with the remainder of the team distributed dependent on where the new patients are. As such, while individual specialities are maintained, the rota is now much more flexible than previously, allowing for a more supportive team environment where no individual pharmacist can be allocated a large number of new patients while others have very few. This process is repeated after lunch, allowing for further flexibility of the service.
The pharmacist review of each patient is documented via a brief electronic pharmaceutical care plan within the HEPMA system. This helps to identify which patients
have been reviewed and alerts other team members to any outstanding care issues. Documentation is also completed within the patient’s clinical notes to provide an audit trail of any prescribing carried out by the pharmacist and the reason why.
The clinical pharmacy team also try to streamline the discharge process by identifying patients likely to go home early in the day and validating their discharge prescriptions at ward level. This allows any issues identified on the prescriptions to be resolved more easily than the can be from the dispensary, as the patient’s clinical notes and the junior doctor writing the prescription are both more easily located.
“Overall, the clinical pharmacy team is able to work together to provide a flexible and supportive clinical pharmacy service which is proactive with regards to the situation within the hospital at the beginning of the day, but also able to react to any changes as the day progresses,” adds Sarah.
SCOTTISH PHARMACIST - 31
The clinical pharmacy team is a large team and consequently it is difficult to provide evidence of each individual’s skills. However, it is without doubt that all team members have their own particular strengths says Sarah, which contribute to the success of the team as a whole.
Integral to the redesign of the clinical pharmacy service was the development of the HEPMA reports which identify patients yet to be reviewed by a pharmacist, patients with identified pharmaceutical review dates and patients prescribed high-risk medicines. These were designed collaboratively within the team, but drew on specific skills of team members to make the project a success. The initial report developed was a prioritisation tool, which places patients in different categories based on their perceived level of pharmaceutical risk – red (high risk), amber (intermediate risk), or green (low risk). A high risk, ‘red’ patient may be prescribed a high risk medicine, such as an anti-epileptic or warfarin, be prescribed a large number of medicines which have not been validated by a pharmacist. The Senior Pharmacist – Electronic Prescribing and Care of the Elderly’s skills were particularly valuable in this project, in terms of the actual design and writing of the reports. However a range of other clinical pharmacists were also involved in the development of the report’s content, applying their individual experience in assessing patients’ medications to ensure the validity of the report. This report is used daily by the team and has significantly impacted on the way the service has developed.
The clinical pharmacy team also benefits from a high proportion of qualified pharmacist independent prescribers.
The team have demonstrated their innovation working towards shared
goals on a number of initiatives.
One has been the development of tools to aid the prioritisation of patients in each ward and identify new patients who have not been reviewed. These reports were then validated by the team as a whole and eventually were accepted for everyday use.
The tool was developed over 15 weeks, with a team of pharmacists working in both medical and surgical wards reviewing 5 patients from each risk category (red, amber and green) per week. A discussion of the appropriateness of the category in which the patient had been placed then took place and a confidence score ranging from 0 (no confidence) to 10 (complete confidence) allocated. The tool was then updated to reflect the discussion and a run chart of confidence scores developed. The run chart is shown in figure 1 (in the supporting emailed document) and demonstrates the increased confidence of the team in the priority report over the weeks.
“Development of the tool in this way ensured that the clinical pharmacy team had confidence in the categories that patients were placed in and therefore confidence in using this prioritisation tool,” says Sarah.
“The overall change of the clinical pharmacy service to the person- centred way of working which has now been adopted arose from the availability of this report and the ability to easily identify all patients requiring a pharmaceutical review. The change in the team’s priorities has led to an increase in the percentage of new patients reviewed by a pharmacist on admission to UHA from around 60% to 75% (and a decrease in the median time taken to verify high risk medicines from around 11.5 hours to approximately 9 hours. •
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