City Hospitals Sunderland – April 2009- March 2011

1. City Hospitals Sunderland NHS Foundation Trust NHS City Hospitals Sunderland – April 2009- March 2011 David G Miller - Chief Pharmacist

2. City Hospitals Sunderland NHS Foundation Trust NHS PHARMACY PROFILE • Current Establishment • 50 wte Pharmacists • 40 wte Technicians • 20 wte Assistants • 5 wte Other • IMM Inpatient Service • - 32 inpatient wards Managing Medicines - Enhancing Patient Care

3. How do we do it? • Pharmacists • Speak to every new patient to find out what medication they take at home and if they are allergic to any medicines. • Compare this to the medical notes and EP and advise the doctors of any changes that need to be made. • Regularly review patients prescriptions whilst they are on the ward • Attend ward rounds and provide prescribing advice • Review medication on discharge to ensure patients are sent home on the appropriate treatment • Communicate any changes to the GP

4. How do we do it? • Technicians • Check Patient’s own drugs • Order and maintain supplies of medication in white lockers ready for patient’s discharge • Organise any additional supplies needed for discharge prescriptions • Counsel the patient’s about how to take their medication and what it is for

5. City Hospitals Sunderland NHS Foundation Trust NHS ELECTRONIC PRESCRIBING • Inpatient EPMA system Managing Medicines - Enhancing Patient Care

6. How many queries? Total of 176 deficiencies were recorded over the five day period. Approximately 25 % of prescription’s were deficient in contents. The majority of deficiencies (83 %) occurred within the prescription contents. Chart 1: Overview of where deficiencies occur Table 3: Overview prescription deficiencies

7. Missing Strength e.g. Bisoprolol 1.25 mg, 2.5 mg or 3.75 mg etc.. Ambiguous e.g. Take three per week. 3 tablets on the same day of the week? one tablets on three different days of the week. Frequency e.g. High dose prednisolone twice daily. Illegible e.g. Cannot read course length, frequency, dosage form etc. Frequency Chart 4: Deficiencies occurring within the prescription contents

8. Prescriptions endorsing was the most frequent action i.e. The contents were understood and annotated to make them more legible, coherent etc... A large proportion of prescriptions were PNC’d i.e. The pharmacist made a professional decision. Pharmacist’s also contacted prescriber’s on a regular basis. The actions taken to resolve queries.

9. Hospital Prescription Journey Arrives in pharmacy Prescription charges Pharmacist clinical check Dispensing Process Accuracy check Prescription Written Issue to Patient Counselling CHEMOTHERAPY Final Release

10. City Hospitals Sunderland NHS Foundation Trust NHS Outpatient Medication Issues • Increased Focus on Medication Errors • 6 Mercaptopurine 50mg daily Mercaptopurine 50mg tablets Six tablets to be taken daily A Patient X00000000 DD/MM/YYYY Managing Medicines - Enhancing Patient Care

11. DEAS (2002) Based on reports of 89 UK Hospitals and 7000 errors (1991-2001)

12. City Hospitals Sunderland NHS Foundation Trust NHS Robot Benefits • Reduced Inventory & Stockholding • Reduced Losses and Discrepancies • Reduced Staffing • Quicker Dispensing Times • Reduced Dispensing Errors • Reduced Floor Space • National Initiatives

13. City Hospitals Sunderland NHS Foundation Trust NHS Labelling Benefits • Closed Loop prescribing to label attached • Can dispense automatically from any ward • Deals with DfD workload • No labels at End of day • Few Unlabelled Packs • More OPD Dispensing

14. DEAS (2002) Based on reports of 89 UK Hospitals and 7000 errors (1991-2001)

15. City Hospitals Sunderland NHS Foundation Trust NHS ELECTRONIC PRESCRIBING • Electronic Prescribing performs well for mostpatients with mostmedicines for mostof the time CfH –Briefing for Pharmacists Managing Medicines - Enhancing Patient Care

16. DEAS (2002) Based on reports of 89 UK Hospitals and 7000 errors (1991-2001)

17. Unprevented Error rates per 100,000

18. Trial in Autumn in 5-7 English Hospitals Leading Pharmacy School led Safe, effective and economic ? Patients Perspective ? Which patients have problems ? Advantages and Disadvantages compared to Traditional Model ? What changes required to maximise benefits? Does it fit principles? Do staff see it as friend or imposition?

19. BENEFITS • “Pharmacist Consult” with every Transaction • Personalised Structured Counselling • Pharmacist Control of Process • Near Patient Dispensing • Reduced Operating Costs • After Hours Service • Peak Hour Queue Management • Delivery to Remote Locations • Less Dispensary more Clinical