So, what are we doing at the moment in the hospital pharmacy in this
context of integrated care?
Well, as pharmacists we are specialists in medicines; we are expert in medicines and
we are expected within the hospital to provide a leadership role around
medicines’ use which of course we do, but also at the moment our prime
focus has been around a safe and effective use of medicines and now,
under the banner of medicine optimisation, we are obviously looking
at patient-focused outcomes as well.
But you can’t be interested in patient-focused outcomes within the four
walls of the hospital.
You have to be thinking about it broader than that.
So we have to be thinking about how we support patients before they get
to hospital and also what happens when we transfer them out of hospital
and how we do that safely.
Colleagues around the country will again be familiar with the work that I
suspect we are all doing in trying to tackle medicines adherence and also
medicines-related admission.
We know that about 5-8 per cent of admissions have got something to do with medicines.
Certainly, locally we have done a similar audit to see what is happening
in our own hospital and it is about five per cent of admissions
acutely were because of – or readmissions were because of - something to
do with medicines.
We are charged also with an extraordinary resource very often.
It’s usually about 10 per cent of our Trust’s
turnover that is in expenditure on medicines and we have to manage that very,
very carefully, which of course we do.
We manage that and we manage to minimise costs, but we
do that in terms of the whole healthcare economy as well, not just around
medicines, whilst at the same time maintaining optimal care for our
patients.
Also, within hospital there is an expectation, as a pharmacist, that I know
my community colleagues, so in January and February we are now
working with a large multiple that we built on site in a contract so we
have interest from the community pharmacy there.
They are supporting us to improve the quality of care for our
outpatients.
I think many of us are trying to do work around preventing and reducing
re-admissions.
One of my colleagues in Newcastle has led a piece of work,
Dr Julia Blackburn, called ‘The Reach Project’.
Medicines reconciliation, our education of patients – that’s very
individual patient-focused education; assessment of patient needs; referral
to community pharmacy – that’s a manual system at the moment;
and home visits where that is required where community pharmacy cannot provide
support.
That seems 2 to be unlocking some activity, particularly
relationships with community pharmacy.
We have had electronic prescribing for adults for all in-patients for the
last four years and that has allowed us to do some really quite clever
things in the last year or so, particularly around making medicines
reconciliation at the point of admission much safer, because we can get
the medicines information captured, put into the electronic record and
then, through a process whereby the junior doctor without transcribing,
converts that to an electronic prescription rather than hand-writing.
We are also using the system to identify high-risk patients and that list of
high-risk patients, those patients who we know are at risk of readmission,
we then follow up with and can do things with community pharmacy.
We are now referring – in fact from 1st July we will be using an electronic
referral mechanism - whereby we can refer to community pharmacy for
them to undertake medicines use review or the new medicine service.
So we are tapping into an already commissioned
approach.
That’s very interesting; it’s very helpful to be able
to do that, but actually I think our next steps are we need community pharmacy
to be commissioned to do things outside the new medicine service and
the medicines use review, so that if we have a patient at home, for example,
that needs support, rather than myself and my team going out to see the
patient, actually I think that’s a role that community pharmacy should
be playing.
Thank you.