02.12.16
Sharing best practice in hospital pharmacy and medicines optimisation
Source: NHE Nov/Dec 16
Benchmarking is going to become a key aspect of improving hospital pharmacy and medicines optimisation. Aamer Safdar, Royal Pharmaceutical Society (RPS) English Pharmacy Board member, explains what work is being done to make this a reality.
Lord Carter’s review focused on making potential savings by the NHS identifying variations in hospital pharmacy and medicines optimisation services. Improvements in medicines management can be made by looking at the system as a whole where patients and health and care professionals interact with medicines.
Whilst Carter focused primarily on hospital pharmacy services, it is critical that the whole patient pathway is considered to ensure that medicines are managed well.
The NHS Benchmarking service allows hospital trusts to see where they are compared with similar trusts in a whole range of factors, and thus identify where there may be some unintended variations. It is by identifying these variations, questioning them and sharing best practice that efficiencies can be made.
The importance of HoPMOP
The Hospital Pharmacy & Medicines Optimisation Project (HoPMOP) is extremely important for hospitals to stimulate change, because it provides a comprehensive dataset for all aspects of hospital pharmacy. This includes the context within which hospitals provide services (e.g. secondary, tertiary, community and mental health), how pharmacies are resourced and how the workforce is structured, what overall medicines budgets there are, and how high-cost drugs are managed and funded.
The important aspect here is for sharing of best practice to act as an enabler for efficiencies, such as sharing how pharmacy staff are used and what activities they undertake to support the medicines optimisation agenda. This could be as simple as using pharmacy assistants on wards to ensure medicine doses are not missed and medicines are supplied to wards and patients in a timely manner.
The key aspects for this project are to first collect and report accurate data about each pharmacy service to NHS Benchmarking ,so that each service has a clear dataset for where their service is now. This can then be compared with other trusts and, also, updated periodically to see where progress has been made.
The first data collection was done in 2014 and already there have been many improvements made when similar data has been collected in 2016. The comparisons between like-for-like trusts are key to enable changes to be made. The key challenges include changing working practices to ensure that change is radical in its essence and is implemented in a coherent and structured way. Staff and stakeholder engagement is key both within and outside trusts, as is continuing patient and carer engagement.
Model Hospital dashboard
A dashboard has been developed for the Model Hospital, which includes a section on pharmacy and medicines. Some examples of the data that is held on this dashboard are: pharmacy staff as part of medicines cost (per weighted activity unit); percentage of medicines reconciliation within 24 hours of a patient admission; percentage of pharmacists actively prescribing; use of Summary Care Record per month; number of days of stockholding; and use of electronic prescribing and medicines administration (ePMA) systems.
Progress has been made with the procurement of medicines, some high cost others high volume, where substantial savings have been made. Examples include £8m that is saved per year on the procurement of soluble prednisolone and annual savings of £55m that could be achieved if everyone moved to a biosimilar formulation of inflixima. An example of progress is the increase in active pharmacist prescribers from an average of 19% in 2014 to 25% in 2016, which is one of the recommendations of Carter.
Trusts have finalised their Hospital Pharmacy Transformation Plans (HPTPs) and sent these to the DH for approval. These plans need to be approved by trust boards. Many trusts are working with local STPs across the local footprint to enable area-wide sustainable change.
The RPS has been fully involved with this, from the outset through its Professional Guidance for Hospital Pharmacy Services (2014) and its Medicines Optimisation Guidance (2013); the former being the most used standards in hospital pharmacy.
The RPS has utilised its Hospital Expert Advisory Group (HEAG), which is a group of senior hospital chief pharmacists from a range of trusts and specialties, to provide its expertise and thus inform the society of where support is needed.
Additionally, the RPS has worked closely with the DH with its seven-day services report and some members of HEAG are part of the Association of Teaching Hospital Pharmacists and the Shelford Group of Hospital Pharmacists.
These groups are involved with discussing how to implement the Carter recommendations in practice and the support that can be provided by the RPS, and others, to inform stakeholders of the challenges being faced.
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