Hospital Pharmacist
Vol 10 No 4 p138
April 2003

Oh, how lucky we are!

By Alison B. Ewing, MSc, MRPharmS

Recently, I attended the European Association of Hospital Pharmacists seventh annual conference in Florence, Italy. The meeting was well organised and well attended in a beautiful city — even the weather was kind! And it is always enjoyable to have the chance to see how other countries provide their services and to learn about different ways of doing things.

There was a wide range of topics in the programme from which to choose, but my main interest was attending the session on automation because I have recently purchased an automated dispensing "robot" for my department. Having gone through the long, arduous process of choosing a particular system, I was keen to learn from those who had used the method for much longer. The Europeans certainly have a great deal more experience in this field. The session promised more information on pharmacy systems as well as the automation of administration at ward level, something we are keen to develop in the long term here. Most systems were linked to electronic prescribing. There is no doubt that Europe is way ahead of the UK in this respect.

There were two speakers from Germany and one from Switzerland — all chief pharmacists in hospitals. The presentations were detailed in the extreme about size, speed, volume, efficiency and accuracy of the machines in the pharmacy. However, there was little mention of the impact on pharmacy staff and the way of working within the departments. One speaker reckoned that automation had saved the time equivalent of 1.5 assistants.

The most surprising element of the presentation was, that when questioned about the total number of staff in the large hospital department, one chief pharmacist replied that they now had three pharmacists and 10 assistants for 1,200 beds! It was obvious that there were no ward-based clinical services in this hospital.

Compare this to our own system: I have a staff of over 100 to cover 1,300 beds with 30 plus pharmacists and the need for more! The UK has only just started to automate but we do have an excellent, well-developed clinical service.

In discussing medication errors, the speakers all referred only to dispensary picking errors. The automated machines seemed to ensure fewer picking errors but there was no reference to them helping with other errors or formulary control. I was amazed to hear that on one 27-bedded surgical ward in the Swiss hospital, there were 316 different medicines held at any one time in the automated dispenser. There seemed to be little or no control over choice.

When a video of automated nurse administration was shown, it was quite clear that the practice of "potting out" the medicines for each patient into small containers, all lined up on a tray, was still prevalent. So, no matter how good the selection of the medication at the nurse's station, there was still the huge potential for human error in ensuring the right pot was given to the right patient!

It was apparent that none of these hospitals had an effective clinical pharmacy service, although some of the posters presented showed that there is an embryonic service emerging in some areas.

We may grumble about the lack of automation development in this country but we do have a clinical pharmacy service to be proud of. When talking to a chief pharmacist in a large teaching hospital in Switzerland, I mentioned the number of pharmacists in my department. She looked puzzled and asked, "What do they all do?" It is hard to explain to someone who has little or no experience of the UK way of working. The focus is different for us here.

For a perfect pharmacy service, I see a merger of these two extremes — fully automated (well, as far as it can go!) dispensaries with ward-based pharmacists and technicians providing a complete service backed up by good aseptic services and medicines information.

This Utopia would require major funding input from Government. But it just might be possible. The Welsh assembly has taken the brave step of earmarking funding for an initial three pilot sites followed by roll out to the whole of Wales.¹ This joined-up approach must be better that the situation in England where each hospital is scurrying around doing business cases, trying to find funding and then going through the onerous tendering process. How much is that costing in time, effort and tears? I know from personal experience the amount of work it involves.

It is time for us to have a joined-up approach like Wales and Scotland — to work together and share experiences. We need to have these improvements to maximise the limited staff we have. The Government must recognise this.

We must also look beyond the "robots" and link them to, for example, pneumatic tube ward delivery as well as electronic prescribing. Once we have these in place, there will be time for real clinical development opportunities.

I believe that we are in a far better situation than our European neighbours because a robust clinical service provides much better patient safety than automation. However, the clinical task would be much easier with robots. We want the best of both worlds and we want it sooner rather than later. There is no doubt that we will eventually catch up with our continental cousins, but just how long will we have to wait?