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DEVELOPMENT OF A 7 DAY CLINICAL PHARMACY SERVICE

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European Statement

Introductory Statements and Governance

Author(s)

S. Antoniou, M. Sullivan, P. Wright, J. Quinn

Why was it done?

The cardiac centre receives over 1800 acute admissions per year, with 20% of patients admitted on weekends. National reports highlight increased mortality at weekends, which has led to a call for the NHS to provide a consistent service throughout the week1. In accordance with the European statements of hospital pharmacy2, there was a need to ensure all prescriptions be reviewed and validated promptly on admission.

What was done?

Implementation of a 7 day clinical pharmacy service to a newly merged cardiac centre.

How was it done?

A successful business case for additional resources allowed for expansion of existing service to be delivered. This facilitated change in working hours for frontline staff, including provision of a shift system ensuring the EU working time directive3 was not exceeded. Expansion of the ward based pharmacy technicians’ role to include ward based dispensing led to timely access to medicines. An increase in the visibility of pharmacy staff at the ward level facilitated a patient facing clinical pharmacy service over the 7 days.

What has been achieved?

All new admissions and discharges are reviewed at weekends with visits to coronary and intensive care. Medicines reconciliation within 24 h is above 95%. 98% of discharge medication is supplied at ward level and 93% prepared prior to discharge prescription written. Feedback from patients, nursing and medical staff has been extremely positive.

What next?

The service is currently provided for patients admitted within the cardiac services. A review is underway to consider staffing requirements to implement the service across the whole site and the trust.

Medication reviews conducted by clinical pharmacist in emergency ward

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European Statement

Clinical Pharmacy Services

Why was it done?

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What was done?

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How was it done?

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What has been achieved?

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What next?

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A NATIONALLY COORDINATED APPROACH TO DEVELOPING HOSPITAL PHARMACY SERVICES IN DENMARK

European Statement

Introductory Statements and Governance

Author(s)

L. Jeffery

Why was it done?

Approximately 450 people work within clinical and ward pharmacy in hospitals in Denmark. Despite Denmark being a relatively small country, these services have developed at differing paces, and sometimes in different directions. The initiative was set up to coordinate development and innovation in this field, across the whole country.

What was done?

A national group was established to coordinate and develop clinical and ward pharmacy services throughout Denmark. The working group consists of pharmacists and pharmaconomists representing the eight hospital pharmacies in Denmark.

How was it done?

In 2012/2013 fifteen people representing pharmacists and pharmaconomists from the five Danish regions were selected to the working group. These people were typically known to be experienced drivers of innovation and development in the field of clinical and ward pharmacy. The working group meets quarterly and additional work is carried out between meetings. There are no extra resources available to members of the group or their workplaces.

What has been achieved?

The group has produced and implemented minimum standards for ward pharmacy across Denmark. Benchmarking has been carried out using these standards and the baseline has been set. Progress will be measured regularly.

New standards for how often medicine shelf-life checks should be carried out on wards have been developed, resulting in the task being carried out less frequently on most wards, thus releasing resources to more clinically related tasks, at a time where extra resources are scarce.

Two national networking days for pharmacists and pharmaconomists have been held, where good initiatives are shared to all the regions and hospital pharmacies in Denmark.

What next?

The group is working on national standards for competency development of clinical pharmacy staff. Other logistics tasks will be scrutinized to see whether resources can be found for further investment in clinically related activities.

More benchmarking will be carried out, measuring other clinical and ward pharmacy activities throughout Denmark.

The work has just begun!

IMPLEMENTING PHARMACIST PRESCRIBING AT SCALE ACROSS A UNITED KINGDOM NHS HOSPITAL TRUST

European Statement

Introductory Statements and Governance

Author(s)

D. Campbell, W. Baqir, O. Crehan, R. Murray, N. Wake, R. Copeland

Why was it done?

Supplementary prescribing was implemented as an attempt to reduce prescribing errors at the point of admission. Pharmacists working in more ‘traditional’ clinical roles would identify errors and then ask junior doctors to correct the mistakes made. Not only did this expose patients to unnecessary risks but this was an inefficient use of resources. Prescribing allowed pharmacists to work much more autonomously.

What was done?

Our initiative was to implement pharmacist prescribing across an NHS hospital trust. We focused on developing and using generalist prescribing pharmacists to enhance their current ward based role. We have adopted an “anytime, anywhere” approach to prescribing, where the prescribing pharmacist, like their medical counterparts, can prescribe any medicine, for any patient, for any condition and in any setting.

How was it done?

Pharmacist supplementary prescribing commenced on a single ward, with staff working within a care plan, managing patients. Independent prescribing allowed prescribing service to be rolled out across the Trust. We now expect all pharmacists to obtain a prescribing qualification as a condition of employment. The pace of development was very much dependent on the rate at which pharmacists could be trained.

What has been achieved?

Supplementary prescribing on the admissions unit showed 39% (127/326) of patients audited were prescribed medication that otherwise would have been omitted. In 2014, of the 49 pharmacists employed, 29 (59.2%) are actively prescribing, with seven also having specialist roles. Seven pharmacists (14.3%) are currently in training. An audit of prescribing showed that pharmacists prescribed for 40% (182/457) patients accounting for 13% (680/5279) of all items. In a separate audit, 4 (0.3%) errors from 1413 items prescribed were detected.

What next?

This process has become embedded across our Trust. Regionally, other Trusts agreed a workforce strategy which included the development and deployment of prescribing pharmacists in the way we have described above.

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