Transcript Is the 7 day service the future of2 72KB Jun 21 2011 03:27:50

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?

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 so medicines are 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 nurses
generally unaware of the service and usually run from the
pharmacy
– 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
Recognised as one of the most important
processes to improve patient safety
 Error in about 50% of initial drug histories

– Problems that occur because of inaccurate DHx:
• Fail to identify toxicity or medicines related admissions
• Patients miss critical medicines (e.g. anti-rej, B-bloc)

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 (possibly
the Tuesday or Wednesday if there is a bank holiday)
Reason for medicines not being
reconciled within 24 hours of admission
Transferred (18%)
Pharmacist busy
with discharges
(5%)
Drug chart
missing at visit
(30%)
Week-end
admission (42%)
Delay in
obtaining history
from sources (5%)
Benefits – medicines use

Improving quality of medicine use
– Optimal dosing
– Interactions
– Therapeutic drug monitoring
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 (e.g….)
– Less patients have to visit GP or return to hospital to collect TTOs

Improved counselling on medicines, including changes
made to their regimen while in hospital
– CQUIN & the National Inpatient Survey
– Opportunity to ask questions

Better documentation of changes to medicines and more
timely communication of discharge summary to the GP
Impact on other areas
Ward staff would get to know the pharmacists
working at the week-end and would be more
likely to involve them
 Development opportunity for pharmacists
participating
 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/ £250 (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

Would need sufficient people to be able to cover holiday,
sickness, maternity leave, recruitment delays etc.
Conclusion
Cost & faff vs. efficiency savings and
improving quality, safety and patient
experience
 Would reduce LoS by directly influencing
discharges and indirectly by preventing
medication errors starting on AMU
