Back to the floor - Pharmacy

I go back to the floor twice a month to find out what it’s like for our patients to be treated here, what it’s like for our staff to work here and to see if there is anything I can do to make it better place for both patients and staff. Our hospitals are enormous places and not all of our staff knows what happens in different departments so part of my blog is also aimed at making it a bit easier to understand for our staff, our governors, our volunteers and anyone else who reads it! I hope my blog gives you a tiny flavour of the fabulousness that I see!

The team put together a timetable for me to visit the Pharmacy Department and right at the top of the list was a period of time working in the aseptic department which meant no make-up or nail varnish. Now I’m quite happy to seen without make-up but I didn’t think I could inflict this on our staff so fortunately they had plenty of other activities to keep me busy!

They set me some key objectives for the visit:

  • Understand the essential role that pharmacy plays in patient care
  • Understand patient safety is the key driver for medicines optimisation, requiring detail and accuracy from all healthcare professionals when dealing with medicines
  • Recognise pharmacists are the experts in medicines
  • Understand how the team operate efficiently and is an integral part of the multi-disciplinary team
  • Chat to staff and see what they think about working in pharmacy

Pharmacy back to the floor The Pharmacy Department has approximately 160 members of staff – roughly 100 in patient services (dispensary, stores and ward based) and the rest in Preston Pharmaceuticals Manufacturing Unit. There are an incredible variety of roles within the department which include pharmacists, pharmacy technicians, pharmacy assistants, pharmacy porters, admin and clerical staff. They dispense in-patient and discharge prescriptions (out-patient work is now done by Lloyds), and supply stock drugs to clinical areas from the main department. The ward based services have pharmacist prescribers, undertake clinical assessment of all prescriptions, give advice to other healthcare professionals and importantly provide advice and support to patients on all aspects of medicines use.  Preston Pharmaceuticals provides aseptic, sterile, non-sterile and radiopharmacy services.

The team issues in excess of 50,000 transactions per month and have an error rate below 0.02% which I know they are constantly striving to further reduce. They are hard taskmasters!  They have a dashboard of Key Performance Indicators (KPIs) that they measure themselves against every month. They are now meeting KPIs for dispensing turnaround times for the first time which is great news for patients!  I know that they are trying to share the information in the KPI spread sheet more widely with staff in the organisation so we can understand the amount of work the Pharmacy team get through and to see their performance.  This willingness to be open and transparent  in order to drive continuous improvement is something I see more and more of in our hospitals.

A new role of the prescribing pharmacist is now in place and has helped to achieve a reduction in the prescribing error rate from 22% to 0.7%.  The new satellite pharmacies have reduced the dispensing aspect of the discharge process from 3h to 20min. These are both incredible achievements in making a difference to patient care and patient flow.

One of the really nice things I got to do was to say a few words in recognition of Naina Kishore Bharucha who was due to retire after 40 years at the hospital.  She started in 1974 when she joined the Training Scheme for Pharmacy Technicians at Preston Royal Infirmary. Naina had a keen eye for self-development and never missed an opportunity to train and develop others. She teaches on the Pharmacy Accuracy Checking Btec course at Preston College, is a mentor, NVQ Assessor and internal verifier for the pharmacy department and Preston College. She was recognised for her effort and commitment by winning Mentor of the Year 2014 at our hospitals. It’s nice to know  that we aren’t losing her entirely as she is keeping up her teaching role!

I spent time in the pharmacy stores and goods receipt area watching the delivery of medicines via a constant arrival of vans and bikes;  it looked pretty chaotic at first till I got used to it and could see the patterns of flow and management and realised it wasn’t chaotic at all but perfectly orchestrated!

In the aseptic area I had to gown up to view the rooms and activity but obviously wasn’t allowed in. My need to remain connected to my mascara and lipstick (for the sake of the folks at my next meeting of course) was too great and therefore I wasn’t allowed to enter the preparation area.  I must say though that as individuals were working alone it did look rather isolated.  I then spent some time with the pharmacy ward based team on MAU and saw them undertake medicines reconciliation, EMIS, order medicines supplies. The process is absolutely rigorous and focussed on patient safety. The team doing the work on MAU were constantly interrupted by other colleagues needing the notes, access to IT, asking questions – all legitimate and entirely appropriate – but so disruptive to the process. Hopefully when electronic records are fully rolled out it will make all their lives easier. I also visited the satellite dispensary in the ward block (a grand name for a very small room!) that was instrumental in helping to provide discharge medicines to the ward patients thus speeding up the whole discharge time. I know they are looking at how this can be rolled out further because it was very successful.

I have to say a special thank you to Bhav Rathod who prepared a pharmacy dispensing induction for me and presented me with my certificate on the 30 April. It was really helpful to follow the process from start to finish and observe my initial medicine request through the IT system result in the robot selecting and producing the  right medicines and deliver them to a dispensing tray right in front of me! Of course there was a lot of human intervention after this to ensure they were dispensed safely - a robot can only do so much!

On reflection I think I met the objectives of the shift; I certainly recognise what expertise we have access to in our hospitals and how integral our pharmacy team are in delivering patient safety, experience and satisfaction. Not only are they professional and patient focussed, they are a warm and genuinely friendly bunch who seem to have excellent relationships in and out of the department. When I was there we were in the middle of Perfect 10 and I heard over and over again ‘what can we do today to make it better for the wards to care for and discharge patients’ Resonates clearly with our values and encouraging to see it in action.

Gareth Price and Andrea Ashton – sincere thanks for all your hard work in arranging this visit. I enjoyed every moment.