Initial observations on the impact of implementation of a seven-day clinical pharmacy service on dispensary activity and performance
Initial observations on the impact of implementation of a seven-day clinical pharmacy service on dispensary activity and performance
Introduction: The need for seven-day clinical pharmacy
services is widely acknowledged, although limited, in the
acute sector of the National Health Service.1,2 Timely
medicine supply is integral to provision of improved
clinical pharmacy services to patients across seven-days,
and is essential in effective discharge planning. There is
a paucity of evidence for implementation of seven-day
clinical pharmacy services, including the impact of service
transformation on dispensary activity and performance.
This limits planning and development of seven-day pharmacy services.
Aim: To assess the impact of a seven-day clinical pharmacy service on dispensary activity and performance, at the main site of a tertiary-referral teaching
hospital.
Methods: A seven-day clinical pharmacy service was
implemented in October 2021. Prior to this, pharmacy services were largely dispensary-based with
clinical pharmacy services for acute and neurosciences admission and limited ward-based services in
other specialities. At implementation, clinical pharmacy technicians and pharmacists (n=16) provided
patient-facing pharmaceutical care for 7.5-hours/day
across all specialities over the weekend; this included
medicines reconciliation, preparation of dischargemedication lists, independent prescribing, counselling and clinical review of prioritised patients. The
weekend dispensary staffing, skill-mix and shift patterns were redesigned to facilitate staff release from
the dispensary rota. Dispensing activity data were
obtained from Ascribe for six months pre- and postimplementation (April 2021-March 2022). Data
were categorised as inpatient/discharge and the mean
number of items dispensed per month analysed using
Microsoft Excel. Discharge turnaround performance was calculated as percentage of discharge prescriptions dispensed within two-hours of dispensary
receipt and obtained from the Prescription Tracking
System. Verbal staff feedback was sought 4-months
post-implementation. The study was deemed a service
evaluation by the Pharmacy Research and Audit Group
and so ethical approval was not required.
Results: Twelve dispensing staff and one pharmacist
were rostered to one of three daily 3.75-hour dispensary shift patterns. Following implementation,
mean total inpatient dispensing activity increased
from 12799 to 13250 items/month (3.5% increase)
and mean weekend activity from 2184 to 2677
items/month (22.6% increase). Mean weekday inpatient activity was stable at 10615 to 10573 items/
month. The mean discharge dispensing activity increased from 9065 to 9837 items/month (8.5% increase): mean weekday discharge from 8498 to 8622
items/month (1.5% increase); mean weekend activity from 569 to 1215 items/month (114% increase).
Discharge turnaround performance remained stable
with 85% discharge prescriptions dispensed within
2-hours, versus 84% pre-implementation. Weekday
performance also remained stable - from 84% to
83% and the weekend performance increased from
85% to 92%. Dispensary staff fed-back that weekend
shift patterns were effective, activity was manageable
and shifts usually ran smoothly and finished on time.
Discussion/Conclusion: Introduction of a sevenday clinical pharmacy service led to an increase in
weekend dispensary activity, which was not offset
by decrease in weekday activity. Importantly, the dispensary performance was not negatively impacted and
weekend discharge performance improved. Increases
could be because of weekend medicines reconciliation,
pro-active medication ordering and pharmacist-led preparation of discharge-medicine lists. Dispensary activity
in Winter 2020 was atypical because of COVID-19,
thus it was not feasible to compare data. Further review, including 12 months data would reduce impact of
seasonal variations in NHS activity. Limitations include
that patient data including length of stay and time to discharge were not within scope.
Keywords: Workload; pharmacy service; hospital;
staffing; patient discharge
ii13 - ii14
McKenzie, Cathrine
ec344dee-5777-49c5-970e-6326e82c9f8c
Cheng, Caroline
38d1e5a7-8f10-404b-846e-88e32bf41f16
Lai, Kit
1982e4b1-af37-4069-9f2c-9cb8f2f4ebe8
2022
McKenzie, Cathrine
ec344dee-5777-49c5-970e-6326e82c9f8c
Cheng, Caroline
38d1e5a7-8f10-404b-846e-88e32bf41f16
Lai, Kit
1982e4b1-af37-4069-9f2c-9cb8f2f4ebe8
McKenzie, Cathrine, Cheng, Caroline and Lai, Kit
(2022)
Initial observations on the impact of implementation of a seven-day clinical pharmacy service on dispensary activity and performance.
International Journal of Pharmacy Practice, 30 (2), .
(doi:10.1093/ijpp/riac089.014).
Abstract
Introduction: The need for seven-day clinical pharmacy
services is widely acknowledged, although limited, in the
acute sector of the National Health Service.1,2 Timely
medicine supply is integral to provision of improved
clinical pharmacy services to patients across seven-days,
and is essential in effective discharge planning. There is
a paucity of evidence for implementation of seven-day
clinical pharmacy services, including the impact of service
transformation on dispensary activity and performance.
This limits planning and development of seven-day pharmacy services.
Aim: To assess the impact of a seven-day clinical pharmacy service on dispensary activity and performance, at the main site of a tertiary-referral teaching
hospital.
Methods: A seven-day clinical pharmacy service was
implemented in October 2021. Prior to this, pharmacy services were largely dispensary-based with
clinical pharmacy services for acute and neurosciences admission and limited ward-based services in
other specialities. At implementation, clinical pharmacy technicians and pharmacists (n=16) provided
patient-facing pharmaceutical care for 7.5-hours/day
across all specialities over the weekend; this included
medicines reconciliation, preparation of dischargemedication lists, independent prescribing, counselling and clinical review of prioritised patients. The
weekend dispensary staffing, skill-mix and shift patterns were redesigned to facilitate staff release from
the dispensary rota. Dispensing activity data were
obtained from Ascribe for six months pre- and postimplementation (April 2021-March 2022). Data
were categorised as inpatient/discharge and the mean
number of items dispensed per month analysed using
Microsoft Excel. Discharge turnaround performance was calculated as percentage of discharge prescriptions dispensed within two-hours of dispensary
receipt and obtained from the Prescription Tracking
System. Verbal staff feedback was sought 4-months
post-implementation. The study was deemed a service
evaluation by the Pharmacy Research and Audit Group
and so ethical approval was not required.
Results: Twelve dispensing staff and one pharmacist
were rostered to one of three daily 3.75-hour dispensary shift patterns. Following implementation,
mean total inpatient dispensing activity increased
from 12799 to 13250 items/month (3.5% increase)
and mean weekend activity from 2184 to 2677
items/month (22.6% increase). Mean weekday inpatient activity was stable at 10615 to 10573 items/
month. The mean discharge dispensing activity increased from 9065 to 9837 items/month (8.5% increase): mean weekday discharge from 8498 to 8622
items/month (1.5% increase); mean weekend activity from 569 to 1215 items/month (114% increase).
Discharge turnaround performance remained stable
with 85% discharge prescriptions dispensed within
2-hours, versus 84% pre-implementation. Weekday
performance also remained stable - from 84% to
83% and the weekend performance increased from
85% to 92%. Dispensary staff fed-back that weekend
shift patterns were effective, activity was manageable
and shifts usually ran smoothly and finished on time.
Discussion/Conclusion: Introduction of a sevenday clinical pharmacy service led to an increase in
weekend dispensary activity, which was not offset
by decrease in weekday activity. Importantly, the dispensary performance was not negatively impacted and
weekend discharge performance improved. Increases
could be because of weekend medicines reconciliation,
pro-active medication ordering and pharmacist-led preparation of discharge-medicine lists. Dispensary activity
in Winter 2020 was atypical because of COVID-19,
thus it was not feasible to compare data. Further review, including 12 months data would reduce impact of
seasonal variations in NHS activity. Limitations include
that patient data including length of stay and time to discharge were not within scope.
Keywords: Workload; pharmacy service; hospital;
staffing; patient discharge
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e-pub ahead of print date: 30 November 2022
Published date: 2022
Identifiers
Local EPrints ID: 477907
URI: http://eprints.soton.ac.uk/id/eprint/477907
ISSN: 0961-7671
PURE UUID: 49904b92-c18d-441c-9bd2-8206f48bcf11
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Date deposited: 16 Jun 2023 16:34
Last modified: 17 Mar 2024 04:23
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Author:
Cathrine McKenzie
Author:
Caroline Cheng
Author:
Kit Lai
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