Ongoing development of clinical pharmacy services

Ongoing development of clinical pharmacy services

Optimising the use of medicines in hospitals is central to the delivery of high-quality patient care. Medication errors in hospitals are still unacceptably common and medicines continue to become increasingly complex and more costly. In addition, this is likely to become a significant issue with payment by results non-elective reimbursement systems, which may result in hospitals not being paid for suboptimal clinical outcomes of care.

The future of medicines management is inextricably linked with clinical pharmacy, with much of the value that pharmacists can add being information provision and monitoring quality. Although there is still a long way to go, the Healthcare Commission noted that many positive improvements have been made since the 2001 report from the UK Audit Commission’s investigation into medicines management in hospitals. Despite the significant progress that has been made in recent years, the Department of Health recognises that there are further challenges requiring attention, and progress in some areas has been slow:

·      ensuring the more effective use of medicines

·      people who need urgent access to medicines are not always getting them when needed

·      accessing the right medicines at the right time – of crucial importance for people at all stages of their lives, but particularly in end-of-life care

·      preventing admissions that could be avoided with proper medicines use

·      there are still too many problems with medicines when people leave hospital and return home.

Pharmacy services in the future will need to be designed around the needs of patients, not organisations, integrated with other healthcare services, with an emphasis on the need to bring care as near to the patient’s home as possible. There needs to be a greater contribution of the skills hospital clinical pharma-cists have developed to the whole patient pathway, making care truly seam-less. Clinical pharmacy must also be designed to make the best use of staff and their skills and take advantage of modern technologies. Although computers and automated dispensing systems can help undertake some of this work, there are limitations to the possible achievements of technology and there is no substitute for direct contact with patients. Clinical pharmacy services in hospital have changed significantly over the past few decades, but re-engineering the way in which patient care is delivered is an ongoing process. Many of the changes are designed to free up hospital pharmacists’ time to focus even more on the delivery of clinical care. Despite their limitations, the use of electronic prescribing and automated dispensing systems can help pharmacists to devote more of their time to patient care. Revision and further expansion of the pharmacy technician and pharmacy assistant roles also need to play a major part in this strategy.

The long-term vision for clinical pharmacy is a service contributing to a health service that offers patients fast and convenient care, that is available when they need it, tailored to their individual requirements and delivered to a consistently high standard. Delivering a successful clinical pharmacy service will bring major benefits to patients and pharmacists alike, but effective medicines management involves the whole organisation and requires multi-disciplinary team working supported by an effective strategy. However, the Healthcare Commission found evidence that a significant proportion of healthcare professionals do not understand how pharmacy staff can con-tribute to the care of patients. It is essential to address this gap to ensure that all healthcare staff and patients gain the maximum benefit from their phar-macy service.