‘A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’.

1. The Patient’s Experience

• Increased by 27% the number of Out-patient prescriptions that can be taken to a Community Pharmacy (Chemist) for dispensing; this increases patient choice and eliminates the need to wait for medicines at the end of a hospital visit.
• Increased the use of Discharge packs of medicines to reduce delays in patient’s discharge, particularly out-of-pharmacy hours (DSU, Eye department, MAU and other clinical areas).

• DTC-approved Patient Group Directions to improve convenience for patients without compromising safety:

• TB immunisation programme.
• Administration of Citanest in Colposcopy.
• Administration of Adrenaline, Influenza vaccine, and Hepatitis B vaccine in Occupational Health.
• Administration of Entonox by Physiotherapists.
• Administration of medicines by nurse hysteroscopist.
• Insertion of Levonorgestrel device by Minimal Access surgical nurse specialist.
• Administration of Gadodiamide by radiographers.
• Supply of nebules by Restart Team (nurses and physiotherapists)

• Involved with action planning following the Patient’s Survey.
• Commenced the supply of cytotoxic medicines to KGH to facilitate treatment at Kettering rather than patients travelling to Northampton.
• Involved patients in survey to change medicine label design (so these can be produced by quieter thermal printers).

1. Use of Information

• Produced four educational Medicine Information Bulletins for medical and nursing staff to address frequently asked questions.
• Drug and Therapeutics Committee approved policies and guidelines placed on the Trust’s intranet.
• Developed IT solutions for the production of Total Medication Summaries for GPs, for Directorate Pharmacist’s medicine expenditure analysis, and for Emergency Duty service activity; these improve the quality of information produced and save time.
• Presentations to both of the Clinical Care in Practice days (Med-N scheme and Patient’s Own Medicines).
• Presentation of NGH Patient Counselling work at National UK Clinical Pharmacy Association conference.

1. Processes for Quality Improvement/Clinical Standards and Monitoring

• Management guidance issued on Dealing with Illicit Substances brought into hospital by patients.
• DTC approved policy for the use of oral syringes in paediatrics (to reduce the risk of oral medicines being administered intravenously).
• DTC approved guidelines on:

• Rapid Tranquilisation of patients.
• Patient Controlled Oral Analgesia following Caesarian Section.
• Rectal Diazepam in epileptics.
• Children’s Pain Management
• Use of Antibiotics
• Thrombolysis in A&E.
• Antifungal Therapy on Talbot Butler ward.
• Management of labour in HIV positive women.

• County-wide Palliative care guidelines developed and issued to clinical areas.
• Multi-disciplinary group established to revise the Prescription and Administration Record.
• Pharmacist on the Trust Discharge Review Group.
• Audited Medicines Brought into Hospital by Patients; Trust approved a scheme for pharmacy staff to manage these; this will result in greater presence of pharmacy staff in clinical areas to deal with staff’s and patient’s medicine problems.
• Transferred childhood vaccine supplies to Health Centres, from NGH to Farillon (commercial sector contracted by DoH).
• Successful inspections by the DoH to maintain the Trust’s Wholesale Dealer’s Licence and the Trust’s Manufacturer’s Specials Licence, and successful external audit of (unlicenced) cytotoxic preparation.

1. Risk Management

• Implemented the National Patient Safety Agency guidance on the safe use of Potassium Chloride injection.
• Risk Incident Investigatory Forum had Medicines as the main agenda item throughout the year as highest priority area to understand and address.
• Peer reviewed and approved by the LNR StHA as having Implemented the National Guidance on the Safe Administration of Intrathecal Chemotherapy.
• Extensive programme to involve staff in improving dispensing activity.

1. Staffing and Staff Management

• Increased pharmacy input to Doctors in Training in acute care and in mental health and in-service nurse training.
• The following educational qualifications were achieved or undertaken:

• Pre-registration tutors piloting the Royal Pharmaceutical Society of GB CPD process.

• Increased pharmacy staff worked hours by 11% (59.98 to 66.75 average worked whole time equivalents) to manage increasing demands; extensive capacity planning in anticipation of demands over the next three years.
• Enhanced clinical pharmacy leadership with a new appointment and re-grading of some pharmacists; re-graded some technical posts.
• Increased the number, and the starting salary, of Assistant Technical Officers; improved likelihood of recruitment and to allow extension of top-up service to uncovered areas; partially funded via increase in external work.
• Involved with the Revive project to produce electronic discharge information.
• Presentations to the Trust Board, Clinical Governance Committee, LIG for Junior Doctors Hours on medicines management; began the formulation of the Trust’s Medicines Management Strategy.
• Authority formally delegated to Drug and Therapeutics Committee to approve policies and guidelines on behalf of the Trust.
• Increased collaboration with Northampton PCT (more shared pharmacy hours, closer working on Formularies etc).
• Extensive county-wide collaboration on planning medicine developments for the Local Health Delivery Plan for 2003/04.

Paul Rowbotham

Chief Pharmacist, May 2003

Attachment: Systems in place to assure quality of Pharmacy Services

Attachment