Pill packetJeremy Chandler
MD, McKesson

Hospital pharmacists have an important role to play in the effective management of medicines, and in determining the ideal drug delivery services to meet patients’ needs. But pharmacy services, rather than being considered a key element in clinical management and patient care, are often tucked away in remote dispensaries removed from both the decision makers and most importantly, the patients.

Pharmacists are a major untapped resource for health improvement. They are skilled health professionals providing expert advice and support in making the best use of medicines. We need to move them out of the pharmacy and closer to the patients and other health management professionals.

More efficient care

Releasing the pharmacist from the dispensary relies on the effective use of technology; a fact very much officially recognised. The Pharmacy Futures report by the Department of Health indicates the future role of Pharmacists and the ways that technology can free up this skilled resource for more “patient facing" tasks, and the OBS for the NHS CRS includes Pharmacy (see section 113 of part 2). It seems however to concentrate on the process of prescribing medication and documenting administration of medications.

Dispensing errors are low in the UK – the average being 16-18 per 100,000, according to The Pharmaceutical Journal. But some of these could be eliminated through technology and automation, if a national approach were taken to introduce these systems into hospitals. The way medicines are managed – from prescription through dispensing and administration – is fundamental to the quality of patient care. There is significant opportunity within the health service to improve quality, reduce clinical risk and minimise waste by using pharmacist resources more effectively if they get out of their dispensaries and onto the wards where they can play a proactive role in delivering patient care.

Robots and cabinets

In the UK much is being talked about robots that improve pharmacy supply systems. Robotic systems, such as the one in use in Charing Cross Hospital, west London, help to reduce dispensing errors and have the capability to pick products rapidly. The uptake of robots on the UK has been quite dramatic; from six installations just 18 months ago to over 25 now. But in the rush to automate, an assumption is being made that a robot is the only solution.

But they are only a small step providing more efficient inventory management within the dispensary. While the robots save space and time and can certainly offer financial gains in better stock holding and reduction of expired stock through improved inventory control, there are instances where robots may not be the most cost-effective solution. The move has to be towards a real-time, integrated clinical pharmacy system that puts patient care at its centre.

A smaller hospital may be able to benefit from a less cost-alternative solution such as automated cabinets, which deliver the right item for the right patient. These could be especially beneficial for smaller hospitals, by picking the stock that is inefficiently picked by robots or sit on shelves outside of any automated solution.

These ‘intelligent’ ward cabinets assist nursing staff in preparing for ward medication rounds. The cabinets receive information from the clinical record system about who the patient is and what medications they are prescribed, and will only electronically “unlock" the appropriate draw or location for the required medication. This helps reduce medication errors caused by selecting the wrong dose or medication for a patient.

At the bedside the patient’s identity band is scanned and the medications for that patient are also scanned. This is a final check that the right medication, as prescribed, is being given to the right patient.

Making use of pharmacists

Using technology in this way will free pharmacists for patient care, for instance, through drug administration – a task often left to the patient or the nurse. With a pharmacist on hand to advise, nurses would no longer have to crush up tablets for older or unco-operative patients. Also, sometimes patients fail to understand the importance of timing each dose correctly – some medications, including those for heart conditions, work better if they are administered in the morning, while cholesterol reducing drugs are more effective when taken at night.

Moving pharmacists or pharmacist technicians into the role of drug administration and replacing packing and stock control by automated services not only ensures greater efficacy of medication but can also provide an essential drug education service. While doctors are the diagnosis experts, they can be supported by the up-to-date pharmaceutical knowledge of the qualified pharmacist.

Research has shown that patients are much more cooperative and responsible about taking medication and are more likely to complete the course when they have more information about the drugs, the way they work, possible side-effects as well as exactly how and when to take them. If the drug expert is educating the patient, not only will they get better care and more information but nursing staff will be freed up in turn.

Educating patients in how to take their medication is important and ensuring compliance when they leave is crucial. Some hospitals are now leaving it up to the patient to self-administer medications as this will educate them to continue when they are discharged.

The profile and status of hospital pharmacy services need to be raised, and the best use made of available staff. Pharmacists should be clearly visible in clinical, patient-centric roles. Automating the pharmacy workflow will allow hospitals to free up this vital resource from routine activities and move them into the centre of patient care.

Over 7,000 individual doses of medicine are administered daily in a typical UK hospital – so shouldn’t pharmacists be higher on the national agenda?

Jeremy Chandler
MD, McKesson