Transcript Is the 7 day service the future of1 112KB Jun 19 2011 03:24:57

Is the 7 day service the future of
pharmacy in acute medicine?
David Young
Contents
What is the current situation with weekend pharmacy cover?
 Is there a need for a 7 day pharmacy
service?
 What would be the benefits?
 What are the challenges with setting up a 7
day service?
 How would it work?

Current week-end pharmacy
service to AMU

Pharmacist visit for 1-2 hours about 10:30 & pharmacy
open until 12
– Current set up allows supply of routine medicines only
– Unrealistic for getting TTOs ready by this time
• PTWR, reviewing sick patients organising urgent investigations etc.
– Pharmacist often not recognised by the nursing staff
• This and time constraints limits ability to be involved with helping to
solve pharmaceutical problems
– For the charts that do go to pharmacy they can be off the ward for
up to 5 hours and therefore often administered late, if at all (likely
to miss a drug round while chart off the ward)
Current week-end pharmacy
service to AMU

TTO service available Saturday afternoon but generally run
from the pharmacy & nurses generally unaware of the
service
– Unable to check notes for omissions or check with patient for an
accurate drug history & to identify medicines available at home
– Chart in pharmacy all afternoon and TTO unlikely to be back
before the end of the day

Service cancelled on Sunday as insufficient TTOs around
the hospital to make it worthwhile

→ Poor patient experience
Is there a need for a 7 day service?

There is already a move to encourage acute
medicine to “embrace” 7 day working
– Known benefits:
•
•
•
•
Rapid assessment allowing a reduced length of stay
Reduced morbidity and mortality with rapid treatment
Lower rates of hospital acquired infections
Improved patient experience
Patients are known to be more vulnerable at
week-ends and out-of-hours
 Demand doesn’t fall significantly at week-ends

AMU admissions by day of the week
(April – May 2011)
Average = 40
Average = 35
45
40
35
30
25
20
15
10
5
0
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
AMU discharges by day of the week
(April – May 2011)
Average = 17
Average = 14
20
18
16
14
12
10
8
6
4
2
0
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Benefits – medicines reconciliation

Improved compliance with NICE (& WHO)
medicines reconciliation target (within 24 hours)
– Admitted late Friday will not have their medicines
reviewed by a pharmacist until the Monday (Tues/Wed
if BH)

Error in about 50% of initial drug histories
– Problems that occur because of inaccurate DHx

Identify toxicity or medicines related admissions
Reasons for medicines not being reconciled
within 24 hours of admission
Pharmacist
busy with
Discharges
Transferred
5%
18%
W/E admission
42%
Drug chart
missing at visit
30%
Delay in
obtaining Hx
from Sources
5%
Benefits – medicines use

Improving quality of medicine use
– Optimal dosing
– Therapeutic drug monitoring
– Interactions
Staff working at the week-end less familiar with
AMU, or even SUHT, policies
 A significant proportion of the interventions made
by pharmacists are made on admission
 Patients less likely to miss significant medicines,
either because of unavailability or prescribing
issues

Benefits – discharges

Reduce delayed & unsafe discharges
– Nurses will prepare simple TTOs but involves risk and complicated
patients end up staying in hospital
– Medication errors not identified
• Example
– Less patients have to visit GP or return to hospital to collect TTOs

Improved counselling on medicines, including changes to
regimen in hospital
– CQUIN & the National Inpatient Survey
– Opportunity to ask questions

Better documentation of medicines and more timely
communication of discharge summary to the GP
– Changes not communicated to the GP
Other consequences
Same people coming regularly would
increase recognisibility
 Less need for on-call service and dispensary
service
 Week likely to be more efficient on AMU
and general medicine wards

Challenges & practicalities

Cost
– Mid-point of band 7
• £35,000 + 25% (costs) + week-end enhancement
• £200/ £300 (Saturday/ Sunday) for a 7.5 hour day
– Possibility this would be offset by efficiency savings

Change hours and need more week day hours
– Would people be prepared to work more at the week-end?
Especially those with families
– Would need to modify rotas
– Would possibly involve partnership with directorates other than
medicine

How would we cover holiday, sickness, maternity leave,
recruitment delays?