Hospital Pharmacist
Vol 9 No 2 p31
February 2002

Review of circulars and official publications
by Alex Bower, MRPharmS

The Audit Commission report entitled, "A spoonful of sugar — medicines management in NHS hospitals" was issued in December 2001. This report highlights the fact that medication errors occur too often, that many patients do not take their medicines as intended after discharge, and that a large proportion of the medicines taken into hospital by patients are discarded.

The number of reported deaths in England and Wales from medication errors and the adverse effects of medicines is on the increase and was almost 1,100 in the year 2000. It was recognised that medicines are now so central to patient care that pharmacy services need to be seen as a core clinical function, not a technical support service.

The need to form effective relationships with primary care is identified as a key issue. For example, these should include joint primary/secondary care formularies, using patients' own medicines, reviewing medication on admission, self-administration by patients, and use of original packs.

Actions to manage risk are also identified, for example, induction and continuing training, identifying and learning from "near misses", electronic prescribing, and integration of pharmacists into the clinical team. The report claims that robotic dispensing systems offer a way to make better use of scarce resources and that these have been shown to reduce both risk and cost. Hospital pharmacy managers may, however, wish to review the evidence in support of such claims, since the report only identifies the benefits from one case study in Wirral Hospitals NHS Trust and quotes a paper which relates to the American system.

Most hospital pharmacy managers would have been working on many of the areas identified for action, but the report will be helpful in highlighting, to general managers and others, how pharmacy services can further improve the medicines management process. This will require additional resources, and hospital pharmacy managers will need to quantify their requirements and then seek support locally. The report provides an opportunity to do this since it lists recommended actions for NHS trust boards. It can be anticipated, however, that progress will fall short of that which would be made by a central directive backed by new funding.

The first edition of a document entitled "Maintaining competency in prescribing — an outline framework to help nurse prescribers" was issued by the National Prescribing Centre in November 2001. The document sets out a range of behavioural competencies to assist individuals in determining whether or not they are carrying out their role effectively. There are three competencies in each of three areas as follows:

1. The consultation, ie, clinical and pharmaceutical knowledge, establishing options, and communicating with patients
2. Prescribing effectively, ie, prescribing safely, prescribing professionally and improving prescribing practice
3. Prescribing in context, ie, information, the NHS, the team and individuals

Each competency is then summarised with an overarching statement followed by a list of relevant behavioural indicators. The document will be of particular interest to any hospital pharmacist who is involved in the provision of training to nurse prescribers and to any pharmacist undertaking some elements of the prescribing role even if this does not yet extend to full independent prescriber status. The document can be accessed at www.npc.co.uk/nurse_pres.htm.

The Scottish Executive issued "Draft national care standards for hospice care — a consultation paper" in December 2001.

The Scottish Commission for the Regulation of Care (the Care Commission) will take over responsibilities for the registration and inspection of voluntary hospices with effect from 1 April.

The document sets out the standards of care which patients can expect, including a section on medicines management, when their care is provided by a hospice. The document can be accessed here.

Health Service Circular (HSC) 2001/026 entitled "Diabetes National Service Framework: standards" was issued on 14 December, 2001.

The document sets out standards in the following areas:

• Prevention of type 2 diabetes
• Identification of people with diabetes
• Empowering people with diabetes
• Clinical care of adults with diabetes
• Clinical care of children and young people with diabetes
• Management of diabetic emergencies
• Care of people with diabetes during admission to hospital
• Diabetes and pregnancy
• Detection and management of long-term complications

Pharmacists could have an important contribution to make on such issues as health promotion (eg, healthy lifestyle and weight control), smoking cessation, and control of blood pressure and screening. Hospital pharmacists working in these areas will need to provide input to appropriate, local multidisciplinary groups to ensure that their potential contribution is considered and incorporated.

Mr Bower is assistant director of strategic development at Wakefield Health Authority