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SCOTTISH HOSPITAL NEWS


COLLABORATIVE WORKING THE KEY TO SUCCESS


The Emergency Care Clinical Pharmacy Team at Wishaw General Hospital works together to provide a clinical pharmacy service to the hospital’s busy medical receiving unit and ambulatory care unit.


Due to increasing pressure on pharmacy services within the medical admissions unit over recent years, the team was expanded to include clinical pharmacy technicians working alongside clinical pharmacists.


The development of the team involved a review of the skill mix of staff who were already working within the pharmacy department, and created new, extended roles for technicians with the aim of improving patient safety at the ‘front door’ of the hospital.


This extension of the team - which now comprises Janis Mackenzie (Senior Clinical Pharmacist – Emergency Care) and Clinical Technicians, Karen Graham, Julie Hill and Lynne Irvine, plus rotational band six and seven pharmacists - has involved the clinical pharmacy technicians undergoing extensive training to enable them to extend the knowledge and skills they have gained from their traditional technical roles, enabling them to now work as an effective part of the multidisciplinary healthcare team on the ward. The technicians are now trained to participate in medicines reconciliation at the interfaces of care, complete care plans and provide patient counselling.


This, in turn, has allowed the pharmacists in the team to further develop their own roles, participating more fully in the multidisciplinary team, working more closely with medical staff and senior decision makers, and functioning as independent prescribers. This has enabled them to have a greater involvement in patient care, and has also allowed time to provide more junior doctor and nurse training to promote medicines safety.


As well as allowing individuals within the Emergency Care team to


develop their own roles positively, the development of the team has resulted in more patients being reviewed by the pharmacy team within 24 hours of admission to hospital. This increase in patient numbers reviewed at the ‘front door’ has also positively impacted on the workload of clinical pharmacists in downstream wards, allowing them to also develop their own skills and move into extended roles.


Following the success of the clinical pharmacy team model at the ‘front door’ of the hospital, clinical technicians performing similar extended roles have now also been added to the Trauma and Orthopaedic pharmacy team within Wishaw General hospital.


The addition of clinical technicians to the pharmacy team participating in the Medicines Reconciliation process at the ‘front door’ has resulted in a greater number of patients having their medicines accurately reconciled within 24 hours of admission to hospital, in keeping with the Scottish Patient Safety programme – Reducing Medicines Harm Across Transitions.


With the aim of reducing medicines harm across transitions, the team interacts on a daily basis with community pharmacy colleagues when reviewing patients who require dosette boxes, or daily or weekly-dispensed medicines. Contact is made with the relevant


community pharmacy on both admission to and discharge from hospital to ensure continuity of care.


There is also regular interaction between the team and other hospital pharmacy colleagues when reviewing patients, who are prescribed specialist medicines from a hospital setting. This includes liaising with colleagues regarding renal, psychiatric, HIV/hepatitis and biologic medicines to ensure continuity of care for these high-risk groups.


The extension of this team has also produced cost-saving initiatives.


The Emergency Care Unit is an acute assessment area, therefore the majority of patients are only in the unit for a short time. If patients are discharged home from the unit, the team clinically screens all prescriptions and liaises with the patient and/or relatives and carers to ensure that they only supply any new or altered medicines when there is a supply of all regular medicines at home. This naturally reduces duplication supply, potential errors and unnecessary waste.


The clinical team also reviews patients’ medication histories and cardexes on admission to hospital and ensures that any unnecessary/ previously discontinued medicines are not prescribed or supplied to reduce unnecessary waste.


When reviewing patients’ medicines on admission, the clinical technicians


highlight any medicines that are involved in current cost-saving initiatives within NHS Lanarkshire to enable the clinical pharmacists to review if any appropriate cost- saving changes can be made during the patient’s hospital admission.


The clinical technicians within the team are currently undergoing training to counsel patients on high- risk medicines, including warfarin and direct oral anticoagulants. This will ensure that a higher proportion of patients are counselled in a timely fashion to promote safer use of high-risk medicines.


All in all, the expansion of the Emergency Care Clinical Pharmacy Team to include clinical technicians has meant that the provision of pharmaceutical care to the unit has improved significantly over recent years.


The team members’ enthusiasm and willingness to help and to become fully integrated with the wider healthcare team on the unit has also meant that relationships with other members of the multidisciplinary team have developed, and this has raised the overall profile of pharmacy within the ward environment.


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