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.
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.
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