SCOTTISH HOSPITAL NEWS
INNOVATIVE TRIAGE SYSTEM IMPROVES PATIENT CARE
Historically, pharmacists have provided clinical pharmacy services to prioritised hospital wards but, due to staff resources, some wards receive no - or limited - clinical pharmacy service, and continuity of care is not always possible during staff absence and due to patient movement.
Now, a team of lead clinical pharmacists (LCPs) from NHS Greater Glasgow & Clyde has worked together on the development of a triage and referral system, and the development and implementation of an IT module of WardView® to support this system - called PhamacyView®.
The LCP group were keen to improve patient equity, by prioritising patients in most need of pharmaceutical care on admission, and following these patients irrespective of location. This was done by adapting a prioritisation system developed by pharmacists in NHS Tayside, and introducing a ward staff referral system, for changes to patient clinical status. The team collaborated with their clinical pharmacists in the development of these systems, and ensured communication across all the acute hospital sites, to finalise systems that could be adopted in all specialties.
Leadership skills were used by Angela Munday, Lead Pharmacist, Patient Services at NHSGG&C, the LCPs and Carl Fenelon, to develop a vision, and change the clinical pharmacy service from a ward-based service to a patient prioritisation service, across the acute services within NHS GG&C. Strong leadership skills were demonstrated by changing the clinical practice of over 140 pharmacists.
The team of LCPs allocated and supervised various triage and referral projects, at pre-registration level and MSc level. They liaised with Senior Clinical Pharmacist, Carl Fenelon, who supervised Erasmus projects, co-ordinated all projects, supported pilots, and compiled a summary of results and recommendations. The LCPs led on adopting new
standards and operating procedures to support the new service.
As a member of the WardView® Project Board, Angela Munday identified the potential for the development of software tailored to the new clinical pharmacy triage and referral service, and led on the initial discussions to progress this with NHS GG&C IT and NuGensis. Angela is now leading on discussion of reporting systems from PharmacyView® to support the LCPs in review of quality of services, and discussion with Primacy Care Pharmacists to consider interface issues and development within primary care.
Ruth Forrest led on the development of PharmacyView®, with support from Lindsay Beverley and Morven McArvail and, together, they developed the PharmacyView® software by deciding on the data set required, and linked with NuGensis and the WardView® project Board. They undertook IT user testing, including links with WardView® and TrakCare®, wrote new SOPs, developed a training pack and delivered road shows to pharmacy staff on all the acute hospital sites. As chair of the LCP group, Ruth ensured ongoing communication within the LCP team, and attended the WardView®
Project Board meetings as required
Fiona MacLean used her clinical, leadership and IT skills to lead on the development of generic electronic care plans to support paper-light working. The existence of a care plan indicated on PharmacyView® facilitated continuity of care and handover, particularly during staff and/or patient bed movement
The subsequent development by the pharmacy team of the PharmacyView® module, fed by WardView® and ultimately TrakCare®, provides real-time data to visibly display patient triage by clinical pharmacists and referrals by ward staff. This improves patient equity by prioritising patients in most need of pharmaceutical care and allows continuity of patient care irrespective of patient movement and subsequent ward location. The filter facility on PharmacyView® to see real-time patient data, triage status and referrals, allows a clinical pharmacy team approach to those patients in most need.
This new model of care has improved patient care by ensuring that those patients in most need of pharmaceutical care are prioritised, and facilitates planned review at appropriate intervals. The PharmacyView® system allows visible recording of the patient
triage status and ward referrals, which facilitates the follow-up of prioritised patients irrespective of ward location, enhancing continuity of patient care and improving communication within the clinical pharmacist team. The system also facilitates daily work planning for both clinical pharmacists and technical staff improving team working and resource allocation.
The change in practice has been approved by the Acute Division Clinical Governance Committee and this new model of care, in conjunction with PharmacyView®, has stimulated visits by other boards in Scotland and by Trusts throughout the UK. Interest has also been expressed within Europe.
The team has now commenced discussions on the reporting systems available from PharmacyView® (fed by TrakCare®) to support clinical pharmacy teams in further improving patient care. Learning is now being shared with pharmacy primary care colleagues to support their practice, and to investigate the potential for improving patient care across the interface.
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