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Hospital pharmacy services given valuable health check

By Maureen O'Sullivan, MRPharmS

Last year, the Royal Pharmaceutical Society published a set of professional standards for hospital pharmacy services (see Box). One year on and a new RPS report detailing the experiences of the first organisations to implement the standards has revealed the overall response to be positive. The report, published last month, also provides a toolkit to help more pharmacy teams start to implement the standards.

To coincide with the publication of the report, pharmacy leaders from England, Scotland and Wales attended the RPS Annual Conference (8–9 September, Birmingham) to share their experiences first hand. Clinical Pharmacist went along to find out what they had to say. 

The 10 hospital standards

Ten hospital pharmacy standards were published by the Royal Pharmaceutical Society in July 2012 and cover pharmacy services provided in acute, mental health, private and community service providers. Divided into three domains, the standards provide a framework for pharmacy teams to help them improve and develop their services.
The 10 professional standards are:

Domain 1: Patient experience

1 — Patient centred
2 — Episode of care
3 — Integrated transfer of care

Domain 2: Safe and effective use of medicines
4 — Effective use of medicines
5 — Medicines expertise
6 — Safe use of medicines
7 — Supply of medicines

Domain 3: Delivering the service

8 — Leadership
9 — Governance and financial management
10 — Workforce

Thirty-five development sites across Great Britain have been putting the standards into practice over the past year. Their collective experience of this process has been published by the RPS to help other pharmacy teams start to put the standards into practice in their own organisations.

For more information visit the Royal Pharmaceutical Society website or refer to previous Clinical Pharmacist articles available on PJ Online.

First impressions

Helen Barclay, clinical pharmacy manager at Wishaw General Hospital, co-ordinated the implementation of the standards in NHS Lanarkshire. “The process helped us to realise that we are actually meeting a number of the standards already,” commented Ms Barclay. “It is good to know that we are doing the right thing.”

Raliat Onatade, deputy director of pharmacy (clinical services) at King’s College Hospital NHS Foundation Trust in London also found it reassuring to know that elements of her organisation’s practice had now been validated by peers through the standards.

For Louise Howard Baker, clinical director of pharmacy at Wrexham Maelor Hospital, the standards provided a framework to help her organisation be more proactive in its delivery of pharmacy services. She said: “So much of what we do in hospital pharmacy is reactive. We react to other people: working faster to get patients out of hospital and trying to do this without compromising patient safety. We often do not think about all the bits around the sides.”

Gaps identified

“We found that going into detail about the different standards and how to measure them was not essential,” remarked Ms Onatade. Alongside a senior team of lead pharmacists, Ms Onatade conducted a service review to identify how her organisation could implement the standards. “We knew our service well and the standards were robust enough to help us clearly identify where we were doing well and in what areas we needed to focus our attention,” she explained. “We went through and rated the 10 hospital standards using a recognised colour coding system; green for standards that were fully implemented, amber for those that required more work and red for standards that were not implemented at all.”

Similarly, NHS Lanarkshire is using a red, amber and green coding system to ensure that it is delivering a high-quality service to the patients and areas that need it most.

“We do not have enough finances to be doing everything everywhere, but at least we are able to make sure we do as much as we can,” said Ms Barclay.

In addition to identifying what changes to the pharmacy service are needed as a result of the standards, Ms Howard Baker is working to align the standards with the overarching health agenda in Wales. “We have 26 standards for health in Wales that we are expected to report on regularly, which can be difficult,” she explained. “If we could restructure our quality and safety agenda into the three domains of the RPS hospital pharmacy standards, I think it would be much easier to manage.”

Barriers to overcome

“One of our main challenges during this process,” explained Ms Onatade, “was prioritising the time to conduct our review. Other things kept coming up and it has taken us a while to get to where we are now.”

Although the standards now have a high profile among the senior pharmacy team at King’s College Hospital, Ms Onatade is not convinced that junior staff recognise how the standards relate to their daily practice. “I think there is work to be done here, not only in our organisation but across the profession; if we believe in these standards we need to engage more newly qualified pharmacists to use them.”

As the co-ordinator of an implementation project that spanned three district hospitals, Ms Barclay acknowledged the process to be time consuming — especially because her organisation has a large number of different specialist teams and she spent a considerable amount of time speaking to each of them.

However, she pointed out that communication across the health board has now improved as a result. “These are hospital-wide standards, not just clinical standards; therefore, the way that each specialist group interpreted the standards was important.”

Target areas

“Using the standards to review our service has helped us focus on priority areas for development. Having the standards has made us focus on where our main gaps are,” explained Ms Onatade. “The main standards that we struggled to meet were around implementing or incorporating the views of patients or their carers and actively using those to improve and develop services.”

Ms Onatade has decided to address this by conducting a survey of inpatients to understand their experience of the pharmacy service and with their medicines while in hospital — something she admitted to have put off for some time. She said: “When we reviewed our service, it was quite obvious that this was a gap that I could no longer ignore.”

According to Ms Howard Baker, a key area of concern is the prospect of seven-day working for pharmacy services. “We are under more and more pressure to deliver services later, longer, on Saturdays and Sundays; however, it is worth trying to maintain that high level of service without compromising patient safety.”

Ms Barclay also pointed out that the service offered at her organisation on a Tuesday afternoon is not the same as the service offered at midnight on a Saturday, and questioned whether any standard could be met fully if the pharmacy is not providing that level of service 24 hours a day, seven days a week.

Measure and review

“Somehow we do have to measure, benchmark and produce the evidence that we are meeting these standards,” said Ms Onatade in response to a question from the audience about how organisations can prove that the standards have been met.

Catherine Duggan, RPS director of professional development and support, confirmed that demonstrating value through outcomes is something that needs to be addressed. She said: “We need to be able to measure what we do. Just because something is hard to measure, that is not an excuse not to measure it.”

Dr Duggan was at the session to share what the RPS now plans to focus on to enable further roll-out of the standards — reflecting the issues identified by the development site programme.

Seven-day working, development of a medicines charter and improving the patient experience of pharmacy services are among the RPS’s priorities highlighted by Dr Duggan. She also revealed that the RPS intends to review the standards in view of the Francis and Berwick reports.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11127247

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