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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR68

An evaluation of drug supply as a component of ward pharmacy activity

By Lekaa Abu Zayed, Keith Farrar and David R. Mottram

Introduction United Kingdom pharmacists currently serve clinical and supply functions when they visit their wards. With the trend towards more patient-oriented services, the pharmaceutical care (PC) model has been introduced in the United States1 and was adopted by the Royal Pharmaceutical Society of Great Britain. PC requires pharmacists to provide more clinical input and pharmacists have to make the best use of their available time. This study has examined how hospital ward pharmacists occupy their time when different supply systems are used.

Method Six National Health Service hospitals across England (A-F) were selected to cover a variety of drug supply systems. Five of these (A-E) used pharmacy ward visit as the main system to transfer drug order details to the pharmacy and additionally one or more of the following supply systems; hatch, fax, telephone, pneumatic tube system.
Hospital F used a computerised prescribing system (CPS) in which prescriptions were transmitted directly to the pharmacy once entered.
In each hospital seven pharmacy ward visits were observed and ward activities were recorded using a stop watch.
The criteria and definitions of ward pharmacists' activities were a modification to those published in the literature.2,3

Focal points

  • The pharmaceutical care model is the new trend in pharmacy practice
  • The pharmaceutical care model is a patient-oriented service that requires more time and input from pharmacists
  • Ward activities were observed and timed in six NHS hospitals with different supply systems
  • In hospitals where pharmacists were involved in supply, an average of less than 25 per cent of ward visit time was spent on clinical services
  • A computerised prescribing system released pharmacists from the supply function and enabled them to spend 68.4 per cent of their time providing a wide range of clinical services

Results Ward activities observed were; monitoring prescription, annotation, clinical, supply, others and travel between wards and the pharmacy and within wards.
Table 1 illustrates the percentage of time dedicated by ward pharmacists on different activities in all study hospitals. In all non-CPS hospitals apart from C, travel and supply contributed to about half of the ward visit.
Table 1

Again, in all non-CPS hospitals except C, clinical services did not exceed 25 per cent of ward visits time.
Pharmacists in the CPS hospital recorded the highest percentage (68) on clinical services.

Discussion The PC model demands a significant input of pharmacists' time. However, the current multi-faceted role of pharmacists is a barrier to its implementation.4 This study shows that when pharmacists are burdened with a drug supply function, less time is available for clinical services, which accords with previous observations.5
In the non-CPS hospitals, priority was always given to supply. Among these hospitals, pharmacists at hospital C had a greater time in which to undertake clinical services due to nurse involvement in the supply function. In this hospital, wards were near to the pharmacy and thus less time was wasted on travel. This contrasted sharply with the situation at hospital D where wards were far away from the pharmacy and pharmacists visited their wards twice daily with the second visit mainly serving supply function. Although at hospital E pharmacists undertook a second ward visit, the presence of satellite pharmacies contributed to less travel time.
Pharmacists at the CPS hospital (F) were not involved in supply function, therefore they were not under pressure to return to the pharmacy to communicate drug orders and spent more time on wards focusing on clinical activities. CPSs free pharmacists' time and provide opportunity of a wider range of PC services.

Liverpool John Moores university

References

1. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 1990;47:533-43.
2. Jenkins D, Cairns C, Barber N. How do ward pharmacists spend their time? an activity sampling study. Int J Pharm Pract 1992;1: 148-51.
3. Beech EF, Barber ND. The development of a self-reporting multidimensional work sampling measure to study ward pharmreacy services in the United Kingdom. J Soc Adm Pharm 1993;10: 157-62.
4. Cotter SM, McKee M. A survey of pharmaceutical care provision in NHS hospitals. Pharm J 1997;259: 262-8.
5. Anderson S. Clinical pharmacy: casting off the chain. Pharm J 1995;255: 831.