The work described here was presented at the Pharmacy Together 2019 conference.
The Walton Centre is a 192-bedded specialist neurosciences hospital. The Trust was concerned that a national reduction in foundation doctor training posts would impact negatively on medical workload and rota commitments. This could, in turn, result in a reduction in quality of care, patient experience, and increase the number of prescribing errors, jeopardising patient safety.
A review of the skill mix and roles of professionals involved in patient care was conducted. Consideration was given to which of the traditional medic responsibilities could equally, or better, be delivered by other healthcare professionals.
Outcomes of the review were to train two existing senior clinical pharmacists to prescribe and to employ two WTE pharmacist independent prescribers (PIPs) to support the neurosurgical teams. Pharmacist technician time was redirected from medicines history acquisition at ward level to pre-operative assessment clinic (POAC). The aims were to improve prescribing accuracy and reduce junior doctor workload.
The presence of a pharmacist independent prescriber on daily ward rounds allows for interventions and ensures medicines optimisation is prioritised.
It took several months to form and establish the expanded pharmacy team. Work was undertaken with the surgical division and the Drugs and Therapeutics committee to determine the remit of these pharmacist independent prescribers, the first to be employed by the Trust.
Audits were conducted pre- and post- implementation and new service activity was recorded. These demonstrated benefits, including:
Division of prescribing workload
Pharmacist independent prescribers wrote 39 percent (1188) of all discharge prescriptions during 2017-18 and prescribed medication on admission for all elective patients admitted on the morning of surgery (a mean average of 126 per month).
Prescribing error rate reduction
Pharmacist independent prescribers demonstrated a prescribing accuracy rate of 99.8 percent (n=532) versus 89.5 percent for medical prescribers (n=2416)
Accuracy of medication data collated in POAC
92 percent of histories collated by pharmacy technicians (n=29) were correct, compared to 17 percent for nurses
Reduction in the time to complete the discharge prescription process
Pharmacist independent prescribers reduced the time to discharge prescription completion for urgent prescriptions by 45 percent (n=33)
The introduction of pharmacist independent prescribers reduced junior doctor workload, consequently freeing time for other patient facing duties and specialty training. The low rate of PIP prescribing errors compared to medical colleagues improves patient safety. The presence of a PIP on daily surgical team ward rounds allows for prospective interventions to patient care and ensures medicines optimisation is prioritised.
Anecdotally, the changes have been well received by patients and colleagues. They have also resulted in greater pharmacy integration into surgical teams, raised pharmacy’s profile across the Trust, and increased PIP job satisfaction.
Balancing the demands of prescribing and ward round duties with other clinical and non-clinical roles can be challenging. With current staffing, there is limited resilience to maintain full service during periods of sickness or vacancies.
The service is now well established and has achieved its aims of reducing junior doctor workload and improving prescribing accuracy. A close working partnership with all stakeholders and careful planning was integral to successful implementation. Expressions of interest in further expansion of the pharmacy team have been received from the neurosurgical teams to allow PIP participation in more ward rounds.
Jenny Sparrow & Ruth Bennett, The Walton Centre NHS Foundation Trust, Liverpool
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Competing interest statement:
The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.