Northumbria Healthcare NHS Trust has an emergency care hospital which was designed without having a pharmacy department on site.The system of medicines supply used and the way that pharmacy staff work within the Trust has made this possible. Pharmacists and technicians working in the trust spend the majority of their time on wards in clinical roles.
One way used to free up their time to carry out clinical work has included the widespread use of over-labelled medicine packs.
What are they? Over-labelled medicine packs are medicines which have a pre-printed label containing dosage instructions and other information. They are stocked on wards and given directly to patients by nursing staff who write individual patient’s names and the date on the pack. They are stored in each patient’s bedside locker, along with any medicines the patient has brought into hospital with them. The over-labelled medicines and patient’s own medicines are used during the patient’s stay and then, where relevant, are issued to the patient at discharge.Why use them?
• Patients don’t need to wait for medicines to come from pharmacy when they’ve been told they can go home and so can be discharged earlier in the day leading to improved patient flow.
• Pharmacy staff can focus on clinical roles rather than remote dispensing and supply of medicines thereby adding more value to patient care.
• Reduces variation in prescribing as there are pre-defined products and doses agreed with clinical staff (which is especially helpful when following surgical pathways).
• Empowers nursing staff when discharging patients.
What are the results at Northumbria?
Only a third of patients need a supply of medicines from pharmacy at the time of discharge from the emergency care hospital.
This means that most patients don’t need to wait for discharge medicine supplies from pharmacy and they can go home much earlier in the day. The system also helps release pharmacists from the dispensary to spend at least 80% of their time on clinical patient facing duties.
How was this achieved?
We challenged the way that many hospital pharmacies typically operate as they often restrict the use of over-labelled medicines packs to out-of-hours, the emergency department or have a limited range.
The Northumbria approach is that if it is OK to do something out-of-hours then it is OK to do it in hours!
This is something that has developed over a long time. Success has led to further use. We review our range of over-labelled medicines regularly and tailor this to the needs of specific wards or specialties. We have found that widespread use of over-labelled medicines, along with the use of patient’s own medicines, reduces the need for supply of medicines to be made at the point of discharge, which in turn reduces patient’s waiting time and frees up pharmacy staff time to focus on clinical roles and add value.We have used this approach instead of satellite pharmacies. We think that pharmacist and technician time is best spent on wards with patients and not in a pharmacy, whether that is a central dispensary or a satellite pharmacy.
For further information contact David Campbell, Chief Pharmacist, Northumbria Healthcare NHS Trust . This is one example where improving pharmacy principles to improve patient flow have been used and others can be found here .