Problem Challenges associated with use of the electronic prescribing system and difficulties in communication between parties led to patient, pharmacist and clinician dissatisfaction.
Assessment of problem and analysis of its causes When Pharmacists had a question about prescriptions, they had to wait for a long time on the telephone queuing system prior to being able to speak to the doctor. This caused patients to wait a long time in the pharmacy whilst the matter was being resolved. Conversely, GPs felt uncomfortable writing prescriptions based on what they were discussing with patients and receptionists and would have preferred direct conversations with the pharmacists. The reception team was also receiving multiple requests for the same prescription from patients causing confusion and unnecessary workload.
Intervention We decided to host evening events for our local pharmacists and practice members. A nominated GP chaired the three-monthly meetings and acted as a point of contact for the local pharmacies. After the first meeting there was immediate enthusiasm and engagement with one another. There was an immediate change in the relations and quality of communication. We have integrated multi professional education into these meetings covering topics such as asthma and dementia.
Strategy for change
- All pharmacists were informed of a bypass number, which directly connects to the Ridgeway surgery without waiting in a long queue. This bypass number works well and is answered promptly.
- All pharmacists were informed of the surgery mobile number for texting urgent queries to the on-call doctor or calling if very urgent, group emails for doctors, nurses, reception and the practice manager.
- We created a group pharmacist NHS email so that emails could be sent directly between the Ridgeway team and the local pharmacists.
- Pharmacies were asked to warn surgery of national medication shortages/unavailability. Consequently, as a direct result of this communications, doctors prescribed alternative medications and therefore avoided patient being prescribed unavailable medications which could have potentially led to increase workload for the pharmacist, doctor in correcting the prescription and therefore ultimately affecting the patient’s satisfaction in the delivery of the medication.
- We have shared lists of vulnerable and palliative patients with pharmacies and the end of life drugs availabilities from the pharmacists have been shared to the practice so we have easier access to these in emergency settings. Ideally, any information that needs to be shared between the Doctor and the Pharmacist should be with the consent of the patient. However, such sharing of medication information is very well accepted by the patients, who are fully aware that this is done for their benefits, and also necessary
- The surgery now shares with our local pharmacists’ flu clinic dates and we as a surgery promote the smoking cessation clinic that the pharmacists run.
Measurement of improvement
- We have worked with the CCG (Clinical Commissioning Group) pharmacist to deliver cost efficiencies including a large reduction in drug ‘specials’, expensive drugs and red/amber drugs such as methotrexate. This project has also helped by reducing medication wastage and reducing repeat medication dispensing.
- This has saved significant sums of money – an estimate being tens of thousands of pounds in a 2-year period.
- The doctors at the practice write electronic pharmacy messages on the prescription paper to communicate results or asking the pharmacy to ask the patient to come in for a medication review.
- This communication is free and saves money.
- We also shared hospital discharge summaries to the pharmacist. The pharmacists say that this has been useful to them in identifying medications changes and ensuring that this is changed on the patient record.
Effects of change
- We have improved communication between local pharmacies and the Ridgeway Surgery team.
- We have increased patient satisfaction and effectiveness of delivery of patient care.
- We have explored the educational needs of pharmacists and clinicians.
Lessons learnt Pharmacists have the same pressures as GP’s and electronic prescribing has a been a learning curve for us all. The surgery’s invitation to meet the local pharmacists came at an appropriate time and as a result of actively listening we are now a multi professional network who are able to achieve the best outcomes for patients.
Messages for others Our innovative and collaborative network has led to multi professional leadership and we have transformed the culture and network at our practice. We hope we can motivate others to innovate in cross team collaboration.
How we have involved patients, carers or family members in the project The Ridgeway patient group have attended the meetings and have expressed: “It was good to be able to share together views and ideas and has given us a better insight into the partnership between doctor, pharmacist and patient” . The committee will now be looking at helpful information that they can pass on to the patients through their patient newsletter.
Possible conflicts of interests There were no conflicts of interests.
Ethics Approval No ethics approval was needed.
Submitted by Dr Lukshmy Jayalingam