Supporting Resources for Hospital Standards

These tools and resources will help organisations implement the Standards in practice.

Contents

  1. Handbook for Hospital Pharmacy Services
  2. Assessment Tool
  3. RPS Benchmarking metrics for acute hospitals
  4. RPS Ultimate guide for Chief Pharmacist (or equivalent)
  5. Case Studies

1. Handbook for Hospital Pharmacy Services

The Standards handbook is a supporting resource which has been updated and published online alongside the RPS Professional Standards for Hospital Pharmacy Services.

We recommend that the handbook is used in conjunction with the Standards and assessment tool to provide you with useful signposting information to legislation, relevant resources and to help with the implementation of the Standards in your organisation.

2. Assessment Tool

The RPS has devised this assessment tool for all providers of NHS and independent hospital pharmacy services, including those in hospitals, mental health, community service, prison, hospice and ambulance settings. 

The aims of this assessment tool are to:

  • Give providers a structured tool to measure performance against the standards
  • Give providers a framework in which they can evidence to regulators and commissioners that they are meeting outcomes
  • Support providers, by giving them individual outcomes and actions plans that can be incorporated into optimising pharmacy services
  • Work with other tools that organisations are already using

The tool can be used as a self-assessment or done as a peer-assessment.

3. RPS benchmarking metrics for acute hospitals

There is currently inconsistency in the way that acute hospitals measure performance when benchmarking. RPS through its Hospital Expert Advisory Group (HEAG) has developed a consensus on definitions for benchmarking metrics relevant to the delivery of pharmacy services and medicines use in acute hospitals.

The aim is to provide a consistent basis for the collection of data which will allow acute hospitals to benchmark performance against each other most effectively. Benchmarking helps identify unwarranted variation and therefore presents opportunity to improve performance within organisations. Definitions look to use existing data sources where possible rather than adding to the burden of data collection. It is acknowledged that this may occasionally lead to compromise in detail/accuracy.

Defining the target range for the metrics is out of the scope of this work, as is accounting for all local variations in service provision (warranted variation); the definitions are national and need to be broadly fit for purpose.

The RPS Hospital Expert Advisory Group will continue identifying and develop further definitions to support the profession in consistent benchmarking. Comments or suggestions for additional definitions can be directed to [email protected].

View RPS benchmarking metrics for acute hospitals - definitions to enable meaningful benchmarking of pharmacy services, and the safe and effective use of medicines.

4. RPS Ultimate guide for Chief Pharmacist (or equivalent)

This RPS guide is for Chief Pharmacists or equivalents. The content in this guide has been developed for England by RPS and CPPE.

The content in this guide is relevant to England but should also be useful to pharmacists in Northern Ireland, Scotland and Wales.

View the guide.

Case studies

Share your examples!

We are keen to hear about examples of how your organisation are using the Standards and implementing them.

To support users of the Standards, we want to develop examples you share with us into case studies for the website. If you have an example of how you are using and implementing the Standards then email us at [email protected]

You can share your example in an email or set up a call with one of the team to talk through your example. Please cover the following points in your examples:

  • Details of your organisation (name, type of organisation)
  • Which standard your example relates to
  • Description of the example (i.e., what is being done, any outcome or result)

Here are some ways that organisations are using the Standards in their practice.

Standard 1.3 Support with effective medicines use

Systems are in place to identify people who may need support, or to allow people to request support with medicines choice and use.

  • Luton and Dunstable University Hospital NHS Foundation Trust
    + EXPAND

    As part of the Trust’s commitment to support ongoing adherence and medicines optimisation, the Interface Pharmacist attends meetings with Domiciliary Care Providers and is the link person with primary care. They also refer patients to the Community Based Pharmacy Technicians and liaise with any other external agencies involved in the patient's care to ensure that the patient is supported in their care. Within the division of medicine pharmacists attend daily board rounds gaining insight into any adherence support patients might require. 

    Monitored Dosage Systems (MDS) have been a particular issue. If a patient is to be considered for initiation of an MDS upon discharge an 'Equality Act' assessment is undertaken by a member of the pharmacy team, to determine if the criteria are met. 

    However, for patients admitted on an MDS, if there have been no changes in care provision then they will automatically be discharged on an MDS. 

    The Trust also has an SLA with a local community pharmacy to provide an MDS, for patients whose regular local community pharmacy cannot provide a timely service at discharge or for patients newly started on an MDS.

    An adherence counselling service for GUM patients, encouraging them to discuss any issues with the GUM clinic pharmacist.

    If it is felt by the nursing, medical or pharmacy team that the patient requires extra support a Medicines Administration Record (MAR) chart can be requested from the pharmacy dispensary. This will illustrate in an easy-to-read format the name of the medicine, the dosage, frequency and formulation as well as the indication it used for. This can be particularly useful for patients being discharged home with a number of new medicines or used as ‘aide memoir’.

    They are currently working with the trust IT department to introduce either the Refer to Pharmacy or PharmOutcomes scheme. This will enable clinical pharmacists to directly refer discharged patients to their designated chemist for a follow up service. This could focus on any medication related issue ranging from adherence concerns to targeted MURs or the new medicine service. 

    When established it is hoped this will help reduce medicines related problems in primary care and potentially reduce hospital readmissions.

Standard 2: Episode of Care

People’s medicines are reviewed for accurate medication history, experiences of their medication and clinical appropriateness.

  • NHS Greater Glasgow and Clyde - Clinical pharmacy triage and handover service
    + EXPAND

    Acute hospitals in Scotland, including across NHS Greater Glasgow & Clyde (NHS GG&C) as well as some hospitals in England have invested in electronic systems, which enable triage, prioritisation and handover of patients across multiple wards and hospital sites (see p.31 of NHS England: Transformation of seven day clinical pharmacy services in acute hospital for full case study).

  • Nottingham University Hospitals - Integrated clinical pharmacy services on the acute medical unit (AMU)
    + EXPAND

    The pharmacy and the acute medicine teams worked together to create an enhanced clinical pharmacy role which integrated closely with the medical team (The full case study can be viewed on p.29 of NHS England: Transformation of seven day clinical pharmacy services in acute hospital).

Standard 2.1 Individual episode of care

At pre-admission, admission, transfer, or discharge, people’s medicines are reviewed to ensure an accurate and complete medication history and to identify medicines related admissions. People are encouraged to bring their own medicines to the care setting, or they are made available when needed.

  • East Lancashire Hospitals NHS Trust
    + EXPAND

    The Trust have developed a Medicines Reconciliation checklist that is used for all non- elective adult hospital admissions. It is designed to be used by a pharmacist, technician or pre-registration student who has an underpinning knowledge of the medicines reconciliation process (any new member of the team is competency assessed on completing the activity by senior pharmacist or technician).

    Each statement in the checklist is designed to act as a prompt so that the right information is elicited in a logical manner such that the best possible drug history is established. The final prompt is to ensure the patients prescription chart (or ePMA list) reflects reality and any anomalies are resolved, so the drug history can be considered as clinically checked.

    In terms of success related to it, the checklist is designed to provide the Trust with the assurance that an effective process has been followed in order to achieve medicines reconciliation. They carry out occasional audits of it; sometimes we have incidents reported where the process has not been followed. If the checklist is used and the SOP followed, invariably the drug history is correct.

Standard 3: Integrated Transfer of Care

As part of the local health and social care system, the pharmacy team ensure safe and timely transfer of information about the person and their medicines between care settings.

The toolkit Hospital referral to community pharmacy: An innovators’ toolkit to support the NHS in England produced by the RPS Innovators’ Forum contains useful case studies (see appendix 1) from the following organisations showing referral systems they use in practice:

Standard 4.4: Digital technology and informatics to support medicines use

The pharmacy senior leadership team, in partnership with the multidisciplinary team, lead the development, implementation, integration, utilisation, optimisation and ongoing monitoring of digital technology and informatics that support medicines use across the organisation and the wider health system.

  • Newcastle upon Tyne Hospitals NHS Foundation Trust
    + EXPAND

    This trust is one of several hospitals nationally who have developed and implemented a model to prioritise patients, as an enabler in providing targeted seven-day clinical pharmacy services. Electronic prescribing systems have the added value of providing intelligence of prescribing activity that occurs during the patient pathway in hospitals (The full case study can be viewed on p.20 of NHS England: Transformation of seven day clinical pharmacy services in acute hospital).

    The clinical informatics team at Newcastle Hospitals was created when the trust introduced an electronic patient record (EPR.) The electronic prescribing (ePx) component of the system was implemented by the pharmacy department with the assistance of a multi-disciplinary project team. Over the last decade the system has been continually developed and is now digitally mature.

    Key to their ongoing informatics development is the Trust’s investment in a permanent pharmacy informatics team. The pharmacist-managed team of pharmacy technicians, led the initial implementation being involved in process mapping, process design, system build and user engagement. They also designed the testing, training and governance processes to ensure safe successful implementation and compliance with information standards for clinical systems. 

    The team have subsequently developed the system in close collaboration with the Trusts IT services. They have provided leadership on several system upgrades e.g., JAC upgrades and creation of a network version of the Trust’s chemotherapy ePx system. The team have also led on the uptake of new EPR functions. An example of this being the development of clinical pharmacy prioritisation tools, which provide a supplement to traditional decision support models. The skills gained during this have benefitted medicines optimisation and wider applications of the EPR such as laboratory services.

    Experience, through continuity of the team, has been an important factor in ongoing improvement. This has been developed through the Trust supporting the pharmacy informatics team to undertake informatics qualification e.g., Informatics degrees, system architecture courses. With a wider understanding of the technical and operational aspects of developing and maintaining an EPR the team has improved in troubleshooting, rule creation, report writing, interface development an example utilising all of these being the development of an EPR-generated and automated community pharmacy referral process (Clinical Handover).

    Another key to success is ensuring the pharmacy informatics team are represented on key Trust groups and committees. Representation at these has been essential to ensure that informatics is developed according to Trust priorities and to ensure that informatics and its opportunities are embedded into new Trust developments with the engagement of key stakeholders.

    Finally, the team are heavily involved in national collaborative forums for informatics. This has greatly enhanced their own knowledge but also allowed them to share their own experiences as informatics centres drive to share good practice.