01.06.15
HEE evaluating results of national emergency department pharmacy pilot
Source: NHE May/June 15
NHE’s David Stevenson gives a progress update on the national emergency department pharmacy pilot.
In the March/April 2015 edition of NHE, we reported that the Health Education England (HEE)-led national emergency department (ED) pharmacy pilot was due to start in March.
Running for a period of five weeks, from 2 March to 3 April, it was confirmed that 53 acute trust ED teams (the full list is available at the NHE website), representing 12 out of 13 national Local Education and Training Boards, were taking part in the programme and the results are now being evaluated.
With an evidence-based study focus for the project, the pharmacists involved, with adequate medical and non-medical support, evaluated a locally chosen sample (to ensure a suitable representation) of 400 ED patient presentations, over the five weeks.
The pharmacists then categorised the patients with regard to whether they could be managed as a part of the multi-professional ED team:
- By a community pharmacist – A&E attendance unnecessary
- By an independent prescriber pharmacist in the ED – with no additional skills training
- By an independent prescriber pharmacist in the ED with advanced clinical skills training (aligned to the non-medical Advanced Practice pathway)
- By a medic only – unsuitable for pharmacist intervention
HEE allocated backfill funding for each of the 53 project pharmacists, sufficient to allow for a maximum of 120 hours of data capture. There was no requirement for data capture to take place on set times or days of the week, so as to minimise workforce disruption and allow trusts to focus their efforts during local peak periods.
It was also suggested that pharmacists should spend an equivalent amount of time in triage and all ED areas (AE majors/minors/out-of-hours GP clinic) to gain a broad spread of patients.
During the project, each pharmacist was allocated a standardised data capture pro forma and asked to submit their first 50 blocks of patient data as soon as possible and ahead of the final submission. This was intended as a quality assurance measure to 1) ensure correct populating of forms and 2) to test the submission and review process by the evaluation team. It is expected that the data from the study will inform the ongoing mapping and development of clinical training pathways.
Initial impact
Although the evaluation of the overall project’s results is still ongoing, with an anticipated interim report date of July 2015 and final evaluation report submission of October 30 2015, the programme is already having an impact.
For instance, East Lancashire Hospitals NHS Trust has confirmed that a pharmacist will now be permanently based in the ED at Royal Blackburn Hospital in an attempt to ease pressure on staff.
Neil Fletcher, clinical director of pharmacy at East Lancashire Hospitals NHS Trust, said: “We are pleased with how the pilot went here and are very keen to take this work forward. We are now looking at putting a pharmacist in the emergency department who can be part of the team there and support with the triaging of patients.”
A HEE spokesperson told NHE that the pilots are designed to identify opportunities to make effective use of pharmacists’ knowledge and skills, working with other key staff in EDs so that patients are seen and treated safely, effectively and in a timely manner.
Back in December 2014, NHS England at its board meeting confirmed that HEE would pilot the role of pharmacists working in A&E departments in spring 2015. This trial is an evolution of a pilot that took place in the West Midlands from December 2013 to August 2014.
At the time, Professor Sir Bruce Keogh, national medical director, said key outcomes would include a positive impact on patient safety, improved patient experience and throughput, expediting safe discharge of patients from hospital and, consequently, an increased capacity in the acute care pathway.
Dr David Branford, Royal Pharmaceutical Society (RPS) English Pharmacy Board chair, said: “The RPS believes that pharmacists could make a significant impact on patient care by adding both capacity and capability to emergency departments.
“Hospital pharmacy has been at the forefront of advanced clinical practice for some time and I have no doubt chief pharmacists and their teams will respond positively to this opportunity. We are fully supportive of the work being undertaken by HEE to further evidence the value of pharmacists within emergency departments.”
In the July/August edition of NHE we will have an interview with a lead on the programme to discuss the pilot and its findings.
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