The Pharmaceutical Journal Vol 267 No 7179 p873-877
22-29 December 2001

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Central role for hospital pharmacists identified by Audit Commission

Pharmacists have a central role to play in managing medicines effectively in hospitals, according to an Audit Commission report published this week.

The report, "A spoonful of sugar — medicines management in NHS hospitals", aims to raise the profile of medicines management in secondary care. It states that pharmacists have a central role to play in redesigning services around patients' needs and in ensuring the optimal use of medicines.

However, it points out that many pharmacy services do not have direct influence on clinical management and highlights recruitment and retention problems in hospital pharmacy. "The profile and status of hospital pharmacy services need to be elevated and best use made of the available staff — registered pharmacists should concentrate on their clinical, patient-centred roles," the report recommends. "Pharmacy services need to be seen as a core clinical function, not a technical support service."

The report says that shortcomings in medicines management arrangements are evident in many hospitals. "Medicines management now needs to be developed to fit into an overall structure for clinical governance," it says. This will help to assure effective clinical practice and to minimise the risk of medication errors.

An increase in the number of deaths associated with medication errors and adverse effects of medicines is identified by the report. It suggests developing clinical pharmacy services and use of computer technology and automation to reduce such errors. "Pharmacists need to be integrated into the clinical team. Pharmacists are experts in pharmacology and bringing them closer to the patient improves the quality of care and reduces costs. Pharmacists should be used to anticipate medication errors," the report recommends. Pharmacists have traditionally had a role in quality control in checking patients' medication. "Typically, between one-fifth and one-quarter of inpatient prescription charts are amended by pharmacists for a variety of reasons that reflect shortcomings in the basic rules for safe prescribing."

Keith Farrar, chairman of the Royal Pharmaceutical Society's Hospital Pharmacists Group and chief pharmacist, Wirral Hospital, welcomed the report. "The real benefits to patients are in hospital pharmacists being involved directly in clinical care at the patient's bedside to optimise treatment and minimise risks," he told The Journal. "Automated dispensing and electronic prescribing are useful tools but neither is a substitute for pharmaceutical care at the bedside," he added. Automated dispensing helps to free staff time, particularly that of technicians, allowing staff to spend more time on wards. Mr Farrar added: "I hope trusts and boards will see the need to invest in pharmacy services in order to accrue the benefits."

The report defines the role of clinical pharmacy as: "Applying pharmaceutical expertise to help to maximise medicine efficacy and minimise medicines toxicity in individual patients. It allows pharmacists to become part of the clinical team and to anticipate medication errors." It says that the presence of a pharmacist on ward rounds as a "full member of the patient care team" reduces prescribing errors significantly.

The report also suggests that attitudes need to change within the profession and that in some pharmacy services there is an inherent conservatism. Pharmacists need the skills of persuasion and negotiation to manage working relationships with clinical colleagues, it says. The Royal Pharmaceutical Society should review the adequacy of its support for hospital pharmacists' education, training, continuing professional development (CPD), professional competence and workforce planning arrangements, the report recommends.

The Society welcomed the report's recommendations and is currently involved in developing CPD and in workforce planning with the Department of Health. Marshall Davies, the President, said: "Pharmacists have a key part to play in redesigning services around patients' needs and the message is clear: hospital trusts need to improve the way they manage medicines."

Staff shortages among pharmacy staff are recognised by the report. It says that one in six pharmacy posts is vacant and that half of hospitals in the United Kingdom are unable to provide all their intended pharmacy services because of staff shortages. It suggests that recruitment and retention problems could be tackled by introducing more flexible working patterns, redesigning and enriching jobs to focus on clinical pharmacy and introducing automated dispensing. Trusts should undertake reviews of pharmacy staffing levels, it recommends.

Ron Pate, chairman staff side, Pharmaceutical Whitley Council, told The Journal that hospital pharmacists' pay needs to be addressed. "It is vital that pay awards to hospital pharmacists are no less than those offered to the best in the Pay Review Body group [which this week announced increases between 3 and 7 per cent for doctors, nurses and other health professionals] if the NHS is serious about recruitment and retention of hospital pharmacists."

The report applies to England and Wales. It is available from Audit Commission Publications, PO Box 99, Wetherby LS23 7JA, tel 0800 502 030, priced £20, and on the commission's website (www.audit-commission.gov.uk).

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