What is the model hospital pharmacy department? David Campbell Chief pharmacist and clinical director for medicines optimisation
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