Comment

Hospital pharmacy: a Welsh perspective

By Bob McArtney BSc, MRPharmS

As in most parts of the UK, Wales has its fair share of vacancies and underestablishment, however, the practice levels of pharmacy staff have never been higher.

The National Assembly for Wales (NAW), previously the Welsh Office, has actively supported the delivery of health care via the hospital pharmacy service — evidenced most recently by the addition of a new All Wales post in education and development. A network of such posts has been created over the years with pharmacy specialists in quality assurance, drug information, community services pharmacy, purchasing and computing, research and development and my own post in clinical pharmacy.

In addition to the replacement of health authorities from April 2003, a key document was lodged with the Minister of Health and Social Services, NAW, in April — the report of the Task and Finish Group for Prescribing in Wales. This document contains a large number of recommendations, which if implemented, will impact significantly not only on health care, but pharmacy practice — both hospital and primary care.

Hospital pharmacy takes its direction not only from the NAW, but also the trust chief pharmacists’ committee. This organisation was created to overcome the potential divisiveness of the original competitive concept of trusts. A substructure of committees inform the main committee — reflecting the views of the All Wales Specialists and including a dispensary group and workforce planning group (the latter benefits from NAW workforce staff input).

The Welsh Centre for Postgraduate Pharmacy Education is unique among its peers in that it provides education opportunities to community and hospital pharmacy staff — including support staff. It draws advice and support from the chief pharmacists’ sub-committees to ensure that the needs of the hospital service are met accurately.

The Welsh Committee for Professional Development of Pharmacy sets the overall strategy of postgraduate education. It has representation from most areas of pharmacy practice and also benefits from non-pharmacy representation.

The highly regarded Diploma in Clinical Pharmacy, based in the Welsh School of Pharmacy, was created in 1988. The diploma and also the MSc are extremely valuable resources in maintaining staffing at junior grades and provide an excellent grounding in clinical pharmacy skills which underpin the service delivery essential to the hospital service. Vacation placements and final year undergraduate experience further support this.

Patient review

Many hospitals have focused their inpatient services on reviewing patients on admission to hospital, using patients’ own medication and supporting this with near-patient services to facilitate discharge.

The greater interaction with patients is crucial to the job satisfaction of both pharmacists and technicians. Technical staff play an ever greater role in patient care by assessing patients’ own medicines for suitability for use, providing further supplies and basic information on the medicines, and assembling the patients’ drugs for discharge.

Research has been carried out regarding hospital pharmacists working between primary and secondary care. The work of hospital pharmacists providing prescribing support across the primary/secondary interface has shown positive results, and avoids the “us and them” conflict too often apparent when such matters are discussed between the two sectors.

In addition, hospital pharmacists have successfully implemented schemes facilitating communication between community pharmacists and hospital pharmacists with proven benefits to patients.

Hospital pharmacy in Wales continues to innovate and develop all aspects and areas of practice — including sterile production, purchasing, aseptic dispensing, clinical services and drug information.

The future

What does the future hold? Undoubtedly significant challenges lie ahead for hospital pharmacy in Wales. Recruitment and retention of staff is of even greater importance with the Assembly’s desire to move to extended weekday hours and a seven-day service, encompassing clinical, dispensing and aseptic services. Leadership and succession planning must also figure high on the workforce agenda.

In my opinion, many of the advances inherent in the Welsh NHS plan can only be achieved by substantial investment in technology. Improved communication across the interface is only one feature. The potential impact of automation and electronic prescribing on the structure and activity of hospital pharmacy is immense.

Pharmacist prescribing (supplementary or independent) will impact on time, skills and training. Some trusts already have pharmacists providing clinic services to patients taking anticoagulants, disease modifying antirheumatic drugs, and in pre-admission clinics. Work is under way to produce a series of standards and skills which pharmacists providing these services require.

Competence and fitness to practise are the key to ensuring the quality of all pharmacy services regardless of the staff group providing them. This underpins clinical governance. Continuing professional development is recognised as crucial to the future of the service and must be implemented across the board to ensure that services and staff develop, thus achieving many of the key government and service interlinked goals. To support this, the concept of quality assurance must be applied to services not just products.

A considerable amount of work has already been carried out in conjunction with the (previously Welsh Office) value for money unit in producing guides to support service development based on evidence of effectiveness. Benchmarking services between hospitals has been ongoing for some time and key performance indicators need further development.

This leads finally to clinical risk — a key role for pharmacy. Considerable research has been carried out on all aspects of errors. The dispensing error scheme based in the University Hospital of Wales is well recognised. This project is now resourced to allow computerised analysis of events to better inform preventative strategies.

Some hospitals have implemented medication error and near miss schemes that complement the broader hospital clinical risk reporting schemes. The information obtained and the subsequent corrective action taken requires broader dissemination. It is anticipated that this will be forthcoming through a Welsh error reporting scheme. Hospital pharmacy is alive and well in Wales — come and see for yourselves, I guarantee you don’t need to speak Welsh!

Mr McArtney is All Wales Specialist in clinical pharmacy, based at University Hospital of Wales. He is also a practising clinical pharmacist and directorate pharmacist for cardiac services, UHW