SCOTTISH HOSPITAL NEWS
IMPROVING PRODUCTIVITY IN HOSPITAL PHARMACY
For some years now, there has been recognition that hospital pharmacy services need to respond to the changing environment in the provision of their service. This is particularly so with an increasingly frail elderly population, a drive to decrease the length of stay, improved flow, the move towards seven-day services and new developments which are designed to modernise outpatient services.
At the recent Pharmacy Management Forum in Dunblane, Melinda Cuthbert, Associate Director of Pharmacy (Acute & SCAN) at NHS Lothian, and Janice Watt, Lead Pharmacist Acute Services, NHS Greater Glasgow & Clyde, told delegates about how seven-day working could improve patient care and led a discussion on how such an expansion of resources might be resourced.
‘The issue of seven-day working is very much to the fore at the moment,’ Melinda told SP, ‘With its inclusion in Dr Rose Marie Parr’s recent ‘Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland’ document.
‘In it, Dr Parr emphasises her commitment to developing a plan to support the delivery of safe, effective and productive working across seven days, including increased focus on the prioritising of direct frontline care, the consideration of clinical activities that need to be prioritised on weekdays and at weekends and an increased role for remote consultations and mobile working.
‘Dr Parr also emphasised the need for an appropriate skill mix, which is underpinned by advanced practice frameworks for both pharmacists and pharmacy technicians. ‘Achieving Excellence in Pharmaceutical Care’ obviously builds on the policy eschewed in 2015 by the Sustainability and Seven Day Services Taskforce Interim Report, which highlighted that its aim was to ensure that ‘people requiring healthcare have timely access to high quality, person-centred, safe and effective care when they need it, regardless of the time or day of
the week, and on a basis which is sustainable in the long term.’
‘So, how do we ensure the provision of high-quality seven-day services in hospital pharmacy? Well, I believe that best possible outcomes and experience for patients can only be achieved by using available resources in a sustainable manner. We need to look carefully at issues such as whether we need to aim for the same service seven days a week and to assess what would be the most effective and efficient service at weekends for the service users. We also need to ensure that all patients have continuity of care including the capacity to be discharged - and supported in their discharge from hospital seven days per week.’
In order to progress the idea of seven-day services, two pilots have already been run in Scotland to ascertain what a ‘best practice’ model for seven-day services would look like.
In NHS Greater Glasgow & Clyde, a pilot was run, which involved providing a clinical pharmacy service at weekends, in addition to the traditional dispensing and supply service. The service was then evaluated over four consecutive
weekends. A clinical pharmacist also operated in the Acute Medical Unit (AMU) between 9am and 3pm on Saturdays and Sundays.
During the pilot, 375 new patients were reviewed over four weekends (80 per cent of total admissions through ARU). Through these reviews:
• 113 medication reconciliations accuracy were confirmed by the pharmacist
• 54 per cent of medicine reconciliation documented by medical staff required changes due to discrepancies and omissions
• 60 per cent of drug charts reviewed resulted in a change
• 57 per cent of discharge prescriptions required a change of which 50 per cent were clinically significant.
In NHS Dumfries & Galloway, meanwhile, a one-year, fully-funded pilot is currently in progress in which a clinical pharmacy service is being provided to new medical and surgical admissions from 8am to 8pm seven days a week. This is supported by pharmacy technicians and an assistant technical officer (ATO).
Here, the duties included the triaging of all new admissions and acting on any immediate pharmaceutical care issues by pharmacists; medicine- related queries; attendance on admission ward rounds and the facilitating of a discharge medicine process and clinical check of IDLs. Technicians check medicines reconciliations and identify any discrepancies while ATOs deal with the movement of medicines with patients around the hospital and assisted with supply.
‘A variety of models have now been tested,’ said Janice Watt, ‘and while the data collected has clearly shown significant benefits for patients, to date there is no clarity on the best model that should be put into practice. There are still so many issues that still have to be looked at, such as, if there is no additional resource for seven-day services, how we can change current services to release the necessary resource. We also have to assess how we manage the human resource aspect of seven-day working and look at how we would change the terms and conditions to incorporate more flexible working. The main challenge, however, is, I believe, that of obtaining sustained funding for
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