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Record learning outcomes

The UKCPA residential symposium was held at the Nottingham Crowne Plaza Hotel towards the end of last year. Christine Clark reports

Pharmacist prescribers make fewer errors

Errors made by prescribing pharmacists occur at a rate of 0.3 per cent, according to an award-winning project presented by Olga Crehan of the Northumbria Healthcare NHS Foundation Trust. A study of pharmacist prescribers carried out by the foundation trust used the same methodology as the EQUIP study, which looked at prescribing errors made by medical prescribers. The EQUIP study reported a mean error rate of 8.9 per cent. In Northumbria all hospital pharmacists are trained as prescribers and they use their prescribing ability to enhance and expand their daily activities rather than opting for specialist work, explained Crehan. Previous studies in the trust had shown that “regular medication omitted from the prescription” accounted for 57 per cent of prescribing errors.

Ward-based clinical pharmacists examined prescriptions written by pharmacists on all wards on three hospital sites over a period of 10 working days. A total of 1,415 medication orders for 155 patients were included. Four errors were identified, equivalent to a rate of 0.3 per cent. Medication reconciliation was improved considerably when pharmacists undertook routine prescribing. The initiative was well-received by doctors who said that prescribing by pharmacists prevented unnecessary delays in treatment. The study was awarded the UKCPA/Pfizer Medication Safety Award.

Medicine-related readmissions

A scheme designed to reduce avoidable medicine-related readmissions to hospital has delivered positive results, according to Julia Blagburn (Newcastle upon Tyne Hospitals NHS Foundation Trust). The scheme was built on the hypothesis that patient-centred care – that is, meeting each patient’s need for information, risk management or support with their medicines – might reduce the need for readmissions. Medicines reconciliation at each interface and access to the NMS or targeted MUR services were central to the plan. Medications that were strongly associated with readmission were identified from the literature and “pharmaceutical care bundles” were developed by the pharmacy team. The team found that about 50 per cent of people eligible for MURs/NMS could not access them because they were housebound, cognitively impaired or their community pharmacy did not offer these advanced services. The majority of these accepted a call or visit from hospital pharmacy staff instead. Telephone follow-up by a pharmacy technician with a medicines management qualification (using the MUR/NMS templates) typically took five minutes per patient; home visits took 20 minutes plus travelling time.

The majority of interventions provided by the pharmacy technician related to information about medicines and adherence to medication regimens. A wide variety of medicine problems were resolved by the pharmacy technician after discharge and the support of a pharmacist was rarely required. Of note, pharmacy staff on the intervention ward identified a larger number and range of practitioners to communicate with at discharge than the nursing staff identified on the control ward. The results showed that the scheme works in practice although Blagburn cautioned that more work might be needed to understand and improve its efficacy. There was an absolute reduction of 11 per cent in the readmission rate during the intervention. In July 2014 an electronic referral pathway from hospital to community pharmacy was established using the Pharmoutcomes web portal. So far, around 400 patients have been referred for a MUR or the NMS.

Half of patients eligible for MURs/NMS could not access them