What is the model hospital pharmacy department?

David Campbell

Chief pharmacist and clinical director for medicines optimisation

Difficult to quantify/measure . . .

• Many variables: technology, geography, available workforce, local priorities/opportunities, etc.

• One size doesn’t fit all

• Increasingly complex

– Multidisciplinary; not just pharmacy department

– Cross organisational/integrated; not just hospital

• Lots of metrics but limited use in isolation

Flow: supporting discharge

07:00:00

08:00:00

09:00:00

10:00:00

11:00:00

12:00:00

13:00:00

14:00:00

15:00:00

16:00:00

17:00:00

18:00:00

0 10 20 30 40 50 60

Tim

e

Discharge Prescription

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

% Patients with UOD 1.2% 18.5%

(A)Pharmacy Assistant

supporting Nurse

(C) Single Nurse on Control

Ward

Omitted medicines: supporting nurses

• Significant difference between the Intervention (A) and the Control (C) groups in terms of unacceptable omitted doses

• I in 5 versus 1 in 100

• ARR = 17.4%

n=2

n=68

P<0.0001

Conceptual difference between

effectiveness & efficiency Effective Efficient

Doing the ‘right’ things Doing it ‘right’

Adds value Reduces costs

Transformational Transactional

Radical Incremental

Effective

• Doing the ‘right’ stuff e.g.– Clinical; adds value to patient care; value seen external to service; judged

using important clinical outcomes; typically required 365 days of the year

– Pharmacists prescribing routinely for all inpatients; medicines review as part of medicines reconciliation process; other clinical roles; facilitating discharge; operating across and into primary care; clinic roles; requires basic examination skills and other advanced clinical skills

– Technical staff in patient facing roles including; managing patient’s own medicines, drug administration (including IVs), drug history taking, pre-operative assessment clinics, counselling, transfer of care

Effective

• ‘Wrong’ stuff?? (‘variable infrastructure services’)– In-house procurement, supply and logistics (versus

automation/centralisation/outsourcing)

– In-house manufacturing/aseptic services (versus outsourcing/regional scale of operation)

– Prescription validation/medicines ordering (versus EPMA, order sets, standardisation of supply)

– Outpatient dispensing (versus treatment recommendation forms)

– On-site discharge dispensing (versus over-labelled ward stock medicines/adopting whole health systems to medicines supply)

Note: in each example a case could be made for this being the ‘right’ thing to do.

Efficient

• ‘Right’ scale

• ‘Right’ numbers of staff

• ‘Right’ AfC band

• ‘Right’ mix of technical and clinical staff (multidisciplinary)

• Using technology where it helps

• Balancing act – patient needs; service needs; staff’s needs

• Adopting human relations approach to leadership/management– Staff working at the boundaries of their capability (whilst being supported)

– Job design/content e.g. responsibility, team work, patient focused

– Staff development

– Job satisfaction/staff motivation

– Leads to higher performance

Questions?

david.campbell@nhct.nhs.uk