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AWARD WINNERS HOSPITAL


PHARMACY TEAM OF THE YEAR


NHS BORDERS MEDICAL ASSESSMENT UNIT


LAST YEAR, THE NHS BORDERS MEDICAL ASSESSMENT UNIT PHARMACY TEAM UNDERWENT MAJOR CHANGES IN THEIR WORKING PRACTICE. PRIOR TO THE CHANGES, THE TEAM HAD WORKED IN RELATIVE ISOLATION, WITH MINIMAL PRESENCE WITHIN ACUTE MEDICINE. THIS MEANT THAT THE TECHNICIANS WERE NOT VISIBLE AND SPENT MOST OF THEIR TIME DISPENSING WITHIN PHARMACY.


Communication between the pharmacy team and the medical team was minimal and consisted of pharmacists writing in green pen within the medical notes. There was no multi-disciplinary approach to medicines safety and medicines reconciliation (by the medical team) was poor.


A change in the medical model of care within Acute Medicine led to improved involvement of the wider allied professionals in delivering seamless care to the patient. As a result, the pharmacists became an integral part of this team and immediately began to focus on ways that they could deliver real-time medicines review, thereby improving patient safety.


The changes that the team have delivered have resulted in a seamless delivery of care from the technicians and pharmacists, and have facilitated earlier discharge of patients from the hospital setting: one of the reasons why this team has been recognised with this year’s award.


Both the pharmacists and pharmacy technicians are now patient facing as much as possible and support each other’s roles. The technicians check the patient’s medications, ensure adequate individual supply, assess compliance


38 - SCOTTISH PHARMACIST


and liaise seamlessly with community pharmacy to inform them that the patient is in hospital. The pharmacists complete medication checks for all patients within the first 24 hours of the patient stay. Wherever possible, this is delivered in real time, ideally immediately after the initial medical review. This check includes a review of medicines reconciliation, venous thromboprophylaxis, polypharmacy and a general, individualised review of each patient’s medications. If required, the pharmacist will then educate the clinician carrying out the initial medicines reconciliation, facilitating this in a constructive manner and ensuring patient safety. Wherever possible, the pharmacist will accompany the consultant on their post-take ward round, providing invaluable advice in relation to the above components and also high-risk medications, compliance concerns/ aids and other complex medication problems. In addition to these roles, the pharmacist will also work with the medical team to deliver anticoagulation counselling, sick day rules advice and real-time delivery of nurse education (for example, missed dosing or early stock ordering for the ward). By facilitating additional training of both the ATOs and technicians, the technicians are now


Joanne Jervis, Daiichi Sankyo and The NHS Borders Medical Assessment Unit Pharmacy Team, Borders General Hospital


able to deliver ward-based dispensing and so, at the time of discharge, the patient’s medication will be dispensed largely from the ward base. This allows seamless delivery of care from the technicians and pharmacists and facilitates earlier discharge of the patient from the hospital setting.


Each member of the team has played a major role in implementing the changes.


Pharmacy technicians Lyndsey and Lynne are an invaluable component of the pharmacy team and, indeed, the wider Acute Medicine team. Having been moved out of the pharmacy and into the wards, pharmacy technicians Lyndsey and Lynne are now building on their ability to be patient facing. This means that they are able to liaise with patients directly and assess their supply of medications, their compliance and any concerns regarding an individual’s ability to administer their own medicines at home. In addition, they seamlessly manage the patient’s medication journey from home to hospital (ensuring supply, supporting the green bag initiative, informing community pharmacy of the patient’s admission and cancellation of any medication due for delivery) and then from hospital to home (through ward- based dispensing and face-to-face explanation of patient’s medication changes). Lynne has led the process of moving the technicians to a more patient-facing role (out of pharmacy)


and has persuaded all of the technician team to try this process, even when many were daunted by the thought. She now has to carefully ensure that they all receive time on the ward as it has been such a successful initiative that they vie for this role!


As a band six pharmacist, Lois has shown enormous initiative in developing new processes within the delivery of pharmaceutical care in Acute Medicine. The senior medical team has endeavoured to capture her energy and she has evidenced her ability to make real inroads into improving patient safety within medicines reconciliation. As part of this process, she has delivered real- time education to the doctors carrying out medicine reconciliation, ensuring an in-depth understanding of the importance of this process.


Cathryn recently returned from maternity leave and has wholeheartedly embraced and continued to develop the changes that have taken place within the Acute Medicine Pharmacy team during her absence. She meets regularly with the Acute Medicine senior medical team to discuss the development of the role of pharmacy, but has facilitated all of the recent changes within her funded establishment with no additional resource. She has actively encouraged initiative within her team and has supported the more junior members of the team to consider alternative methods of working.


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