A recent blog in the Pharmaceutical Journal has tempted me to write this. I am no longer a hospital pharmacist and so look at hospitals from a different point of view. As a patient, I want my trip to the hospital to be as short, smooth and uneventful as possible. I don’t want drama and delay and the pharmacist has a crucial role in this.
On admission it is essential that I am treated accurately and quickly. So I want the right medicine at the right dose, administered in the right way and as soon as possible. The pharmacist needs to ensure three things:
- The clinicians have the right education and information / guidelines available to them.
- The medicines must be available.
- There are checks and measures to ensure safety.
As close to admission as possible, I need a pharmaceutical assessment and medicines reconciliation. This is not just a paper exercise. It does not just depend on what medicines are written, but what medicines are actually being taken. All with a history to understand what medicines may have been taken and discontinued in the past. This information should be infused into the current treatment plan in a structured and organised way.
During my stay, I want all the right medicines administered at the right time and in the right manner. Of course the prescriber (whether doctor, nurse or pharmacist) must prescribe safely, accurately and clearly, but the team needs to ensure that the medicines are given/taken properly. I am a great supporter of self administration within hospital, but the benefits must be achieved and safety ensured. Pharmacists must again ensure three things:
- Those administering medicines or setting up self administration programs have the appropriate education / training / supervision and evidence of competence.
- The medicines must be available.
- There are checks and balances to ensure safety.
When I come to the time of discharge, well, I want to get out of there quickly. Arrangements for my discharge should be set up as early as possible. The medicines need to be there and I need a rudimentary understanding of what I need to do when I get home. It is only when I get home will I open my bag and ask ‘now what do I have to do with these?’ There are two important features here:
- I will start to re manage my treatment the moment that I get home, so during my stay it would be good to have received small packets of information about the treatments that shapes my understanding and decisions.
- Others will seek to reconcile my medicines and treatments and information on what has been stopped, what has been tried and what I am now on would be very helpful.
Both my practice and my community pharmacy have a role in making sure that I am both knowledgeable and committed to treatment. It is worth saying that I will only take the medicines which I believe will achieve the goals that I desire and in the manner that I think is right – so you have an important role in my goal setting.
There is an important link with the community pharmacy through NMS. This may come at a critical time in my medication experience and the role of the community pharmacist must not be underestimated.
I hear lots of discussion about interventions. An intervention is a failure not a success. The whole purpose of a hospital pharmacist is to prevent interventions not to make them. One intervention can be acceptable, but two the same represent systematic failure. Wow that feels a bit strong, but it is the way that we should think. In my early days I provided clinical services to a SCBU. I was worried about the level of interventions. In the main the doses were out, but my main worry was that several had already been administered by the time I arrived. The solution was a formulary, with doses and a calculation and administration guide with education to empower the doctors and nurses. I run sessions for new doctors and additional sessions for nurses on calculations and administration. We also started collecting information on vein survival related to drug administration. My intervention rate plummeted. Well to be truthful it simply brought other issues to the surface to deal with and I had a little more time to talk to parents.
Medicines are an integral part of the effectiveness of a hospital. Pharmacists are the only healthcare professional that can have oversight from prescribing, through procurement and supply to administration and discharge. It is their duty to ensure that every part of the medicine related process is effective and the hospital effectively links pre-admission to post-discharge.