Hospital Pharmacist
Vol 9 No 10 p282
November 2002

Review of circulars and official publications
by Alex Bower, MRPharmS

The document "Meeting the milestones: National Service Framework for older people; supporting documentation for NSF champions" appeared in October 2002, and has website access.

The document has been developed by the Department of Health (DoH) and the Association of the British Pharmaceutical Industry to assist champions and local implementation teams in delivering the NSF for older people. The second part of the document addresses each NSF standard. Section seven on medicines and older people is of particular relevance to hospital pharmacists. Much of the content will be familiar from previous documentation, but the release provides a further opportunity for hospital pharmacists to ensure that the contributions they can make, and any resource requirements needed, are made known locally to the relevant persons.

The document says that, by 2002 (this is interpreted to mean by the end of this calendar year at the latest), all hospitals should have "one-stop dispensing/dispensing for discharge" schemes and, where appropriate, self-administration schemes for medicines for older people. Is that the case in your hospital? If not, why not? Has the term "where appropriate" been used to mean that these schemes have not yet been implemented because of resource or recruitment constraints? If so, what action is being taken and what are the deadlines to ensure full implementation?

The document provides an opportunity for hospital pharmacy managers to review progress and ensure that clear action plans are available to fully implement the schemes.

The Change Agent Team has developed the document "Discharge from hospital: a good practice checklist" to help councils and their NHS partners identify changes needed in advance of a new system of reimbursement for hospital discharge. The new system is to be introduced next April. Hospital pharmacists will be well aware of the importance of patients understanding their medication regimens to ensure a smooth discharge process and avoid re-admission because of medicine-related problems. It is therefore disappointing that there is no direct reference made in the checklist to the role played by medicines in the care of the patient, and hence the potential impact on arrangements for discharge.

Pharmacists are not specifically mentioned, although input would be appropriate in specific areas. For example, section 1.3.2 refers to discharge processes being made by an inter-disciplinary team, and section 2.4 refers to provisions made to prevent/ avoid/divert hospital admissions of older people. Hospital pharmacists may wish to use the checklist as a means of discussing the part that they can play locally in discharge arrangements.

The DoH will shortly be publishing an updated version of the "Hospital discharge workbook", originally published in 1994. Hospital pharmacy managers might wish to identify any changes that they consider appropriate regarding the pharmaceutical role, and ensure that these are conveyed to those involved in the updating process.

"Pharmacy workforce in the new NHS: making the best use of staff to deliver the NHS pharmacy programme; a discussion paper" was issued by the DoH in September 2002. It can be accessed here.

The document notes that new roles have developed recently for pharmacists regarding medicines management in the community, and that effective management of the workforce is needed to ensure that best use is made of pharmacy skills. The good progress made in hospital pharmacy in using the skills of technicians and support staff is noted. However, the document points out that there are variations between hospitals (of between 20 and 80 per cent) in the amount of time pharmacists spend on clinical activities. This suggests that further change is needed in some areas.

The document notes that much better use needs to be made of the way skills are deployed in community pharmacy. It proposes that circumstances should be explored in which suitably qualified pharmacy technicians could provide medicines without supervision by a pharmacist. This would be done under a "protocol medicines supply scheme". Hospital pharmacists will no doubt welcome the opportunity to develop further the effective use of technician and support staff skills, as appropriate. Hospital pharmacy is light years ahead compared with community pharmacy in the way pharmacy skills are used to best effect. However, the profession as a whole has to fish in the same pond when it comes to recruitment and, therefore, hospital pharmacists have a vested interest in facilitating changes in primary care. Comments on the proposals are invited by 31 December 2002.

A "Toolkit for producing patient information" was made available by the DoH in October 2002. A range of templates is provided as being illustrative of good practice and the stages that should be followed when producing written information are set out. The document will serve as a useful guide for any hospital pharmacist who is producing written information for patients, and it is commended on this basis.

The document is available as a PDF (670K).

The NHS zero tolerance zone has issued an updated "Managers' guide" (accessible at www.nhs.uk/zerotolerance). The aim of the guide is to reduce the incidence of violence against staff working in the NHS.

The guide advocates carrying out a risk assessment that takes account of factors which might contribute to violence. These include the environment (eg, cleanliness, adequacy of space, control of access, signage, provision of smoking areas), training of staff and communications (eg, panic button alarms and protocols to log the movement/location of staff). The need to log incidents also is noted. Hospital pharmacy managers will wish to review their arrangements in the light of the guidance and to engage staff in the development of a policy document that outlines arrangements for safe working conditions. This should include guidance on situations where it may be necessary to withhold treatment from violent and abusive patients. This will serve as a useful guide for any hospital pharmacist who is producing written information for patients.

  * PDF files on PJ Online require Acrobat Reader 4 or later.

Mr Bower is a consultant pharmacist