Initial observations on the impact of implementation of a seven-day clinical pharmacy service on dispensary activity and performance

Abstract

Abstract Introduction The need for seven-day clinical pharmacy services is widely acknowledged, although limited, in the acute sector of the National Health Service.1,2 Timely medicine supply is integral to provision of improved clinical pharmacy services to patients across seven-days, and is essential in effective discharge planning. There is a paucity of evidence for implementation of seven-day clinical pharmacy services, including the impact of service transformation on dispensary activity and performance. This limits planning and development of seven-day pharmacy services. Aim To assess the impact of a seven-day clinical pharmacy service on dispensary activity and performance, at the main site of a tertiary-referral teaching hospital. Methods A seven-day clinical pharmacy service was implemented in October 2021. Prior to this, pharmacy services were largely dispensary-based with clinical pharmacy services for acute and neurosciences admission and limited ward-based services in other specialities. At implementation, clinical pharmacy technicians and pharmacists (n=16) provided patient-facing pharmaceutical care for 7.5-hours/day across all specialities over the weekend; this included medicines reconciliation, preparation of discharge-medication lists, independent prescribing, counselling and clinical review of prioritised patients. The weekend dispensary staffing, skill-mix and shift patterns were redesigned to facilitate staff release from the dispensary rota. Dispensing activity data were obtained from Ascribe for six months pre- and post-implementation (April 2021-March 2022). Data were categorised as inpatient/discharge and the mean number of items dispensed per month analysed using Microsoft Excel. Discharge turnaround performance was calculated as percentage of discharge prescriptions dispensed within two-hours of dispensary receipt and obtained from the Prescription Tracking System. Verbal staff feedback was sought 4-months post-implementation. The study was deemed a service evaluation by the Pharmacy Research and Audit Group and so ethical approval was not required. Results Twelve dispensing staff and one pharmacist were rostered to one of three daily 3.75-hour dispensary shift patterns. Following implementation, mean total inpatient dispensing activity increased from 12799 to 13250 items/month (3.5% increase) and mean weekend activity from 2184 to 2677 items/month (22.6% increase). Mean weekday inpatient activity was stable at 10615 to 10573 items/month. The mean discharge dispensing activity increased from 9065 to 9837 items/month (8.5% increase): mean weekday discharge from 8498 to 8622 items/month (1.5% increase); mean weekend activity from 569 to 1215 items/month (114% increase). Discharge turnaround performance remained stable with 85% discharge prescriptions dispensed within 2-hours, versus 84% pre-implementation. Weekday performance also remained stable - from 84% to 83% and the weekend performance increased from 85% to 92%. Dispensary staff fed-back that weekend shift patterns were effective, activity was manageable and shifts usually ran smoothly and finished on time. Discussion/Conclusion Introduction of a seven-day clinical pharmacy service led to an increase in weekend dispensary activity, which was not offset by decrease in weekday activity. Importantly, the dispensary performance was not negatively impacted and weekend discharge performance improved. Increases could be because of weekend medicines reconciliation, pro-active medication ordering and pharmacist-led preparation of discharge-medicine lists. Dispensary activity in Winter 2020 was atypical because of COVID-19, thus it was not feasible to compare data. Further review, including 12 months data would reduce impact of seasonal variations in NHS activity. Limitations include that patient data including length of stay and time to discharge were not within scope.