what is the model hospital pharmacy department?
TRANSCRIPT
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
Questions?