Learning from Gosport: RPS standards for clinical checks of inpatient prescriptions are inadequate

‘Learnings from Gosport: Sharing pharmacy themes, current practice and key resources’ — published jointly by the Royal Pharmaceutical Society (RPS), the General Pharmaceutical Council and the Association of Pharmacy Technicians UK — states that the “RPS standards for hospital pharmacy services … set out what’s expected of a quality service”^[1]
. But in my opinion, ‘Standard 2: Episode of Care; 2.2a’ of the RPS’s ‘Professional Standards for Hospital Pharmacy’^[2]
is not clear and does not provide adequate safeguards.

The standard states: “Treatment requirements are clinically reviewed to optimise outcomes from any medicines prescribed; frequency and level of review adjusted according to patient need.”

With this standard in place, patients admitted as inpatients and prescribed and administered ward stock medicines, including opioids, may never have their prescriptions clinically checked by a pharmacist. How do pharmacists determine the level of review required if they are not aware of a new medicine being prescribed?

It is interesting to compare the RPS’s standards with the Joint Commission on Accreditation of Healthcare Organisations’s standards for hospitals in the United States (JC) and internationally (JCI). The JCI’s standards are much clearer and measurable.

JCI standard MMU.5.1 requires that all medication prescriptions or orders are reviewed for appropriateness before the first dose of the medicine is administered^[3]
.

The goal of an appropriateness review is to improve the quality and safety of adding a new medicine to the patient’s treatment plan and reduce the risk of an adverse medicine event.

According to the JC, the complete appropriateness review must be performed by a pharmacist; however, the JCI standards identify that in countries outside the United States, pharmacists may not be available to check new prescriptions 24 hours per day. The standard states that it is acceptable for other licensed, trained individuals to perform a partial review when pharmacists are not available. When other licensed individuals perform the appropriateness review, they are considered competent to do so by virtue of education and training, as specified by privileging for licensed independent practitioners or have demonstrated competency for nurses or other professionals. However, a full review is required to be conducted by a pharmacist within 24 hours of the new medicine being prescribed.

Further clarity around the RPS’s hospital pharmacy standards is required regarding the clinical checking of inpatients prescriptions in UK to better describe what is expected of a quality service.

David Cousins, independent consultant in safe medicine practice