While the COVID-19 pandemic is very much a natural disaster, the best means of protection for our clinical pharmacy services at NHS Lanarkshire (NHSL) has been remote working technology.
When I took up the post of principal pharmacist in July 2020 at NHSL — full of enthusiasm and ideas, despite the dark cloud of the pandemic — I underestimated the magnitude of the challenges that lay ahead, particularly around workforce and service continuity.
However, I was promptly introduced to the fact that we could allow clinical pharmacists and technicians to work remotely from wards within the pharmacy department, and from home, if required. I was excited to see how this worked in practice; the pandemic had introduced some unique implications for staff protection and absence.
The move to home working for our team was relatively quick and in place before I arrived in the role. It was initiated by the need to allow one of our pharmacists at University Hospital Hairmyres (UHH) to continue working, despite having to shield at home.
Two of the NHSL sites, UHH and University Hospital Monklands, can use e-health systems through secure remote access. The principal one is the Hospital Electronic Prescribing and Administration (HePMA) system, which allows us to manage prescribing and medication administration remotely. HePMA has been in place at Monklands for years, but only at UHH since September 2019. Roll-out of HePMA at our third NHSL site, University Hospital Wishaw, is expected in 2021.
Along with HePMA, PharmacyView, NHSL Clinical Portal, Microsoft Teams, Emergency Care Summary and online labs are our core ‘eHealth suite’. These systems have allowed our teams to easily contact their colleagues and dispensary areas, and prioritise patients. They have been able to continue with tasks such as single-source medicines reconciliation, review of electronic prescription charts, accessing electronic ward nursing handovers, writing and reviewing electronic pharmaceutical care plans and clinical screening of discharge prescriptions — all using these systems.
Working as part of a clinical service at home is certainly a unique experience. Our shielding pharmacist has said that, despite being unwell at the beginning of the pandemic, obtaining secure remote access meant she could go to work without the commute and allowed her to manage her chronic health condition better. She says that being unable to contribute, maintain her knowledge and skills, and connect with the team would have been torture. I was delighted we had this option; team wellbeing has been a key priority throughout the pandemic.
Her adaptability, confidence and commitment paved the way for our head of department to gain secure remote access for the full clinical team, and they were advised to take their departmental laptop or tablet home every evening in the eventuality of having to self-isolate.
The team learned from our pharmacist’s experiences. She says what helped her work most smoothly was having consistent ward areas and patients to review, introduction of electronic pharmaceutical care planning across the whole service and staying connected to her colleagues through Microsoft Teams. Maintaining close contact with the multidisciplinary team on her wards by phone was also essential.
This is not an ideal way to provide a clinical service. Patients and their medical notes are not directly accessible. Communication can occasionally be time-consuming, and single-source medicines reconciliation isn’t preferred. Each time an issue is identified, remote-working pharmacists carry out what can be considered an extended risk assessment: how best to action, the urgency and impact.
But I wonder, had it not been for secure remote access, would our acute services have been forced to collapse down to a dispensary-only function?
Electronic systems are only as good as the information obtained from them, the environment in which they are used and the expertise of the user. The unprecedented level of service continuity and connection achieved by our clinical teams is a testament to their commitment, adaptability and innovativeness during what can only be described as extraordinary circumstances. As a new manager, I will be forever grateful to them and for these options.
Ruth Waters, principal pharmacist — clinical services, University Hospital Hairmyres, NHS Lanarkshire