‘The past is a foreign country: they do things differently there’, is frequently quoted because it applies to so many situations. In pharmacy it is clear that changes are taking place and, in time, we will look back on early 21st century practice and conclude that it was very different. Two topics illustrate this point powerfully, namely the provision of injectable medicines and the delivery of pharmacy services.
The provision of ready-to-use (RTU) and ready-to-administer (RTA) injections is safer for patients and makes more efficient use of health service resources but the drive to obtain products in RTU or RTA forms has numerous ramifications. One of these is dose-banding – now officially approved by NHS England. There is more to this than simply picking the numbers, as Richard Nuttall explained when he described the practicalities at a recent meeting (see page 12). Dose-banding combined with campaign dispensing can release considerable savings, as David Lovett reported to the 2016 GERPAC conference (to be published in HPE 85).
Long-term stability of compounded products will be essential to support the development of RTU/RTA products and evidence in this area continues to emerge. Hospital pharmacists will need to work together with clinicians and with each other to determine which products – concentrations and volumes – should now be made by the pharmaceutical industry as terminally-sterilised products.
However, this raises another question – if RTA products are presented in syringes, they need to be sterilisable, microbiologically robust and also unlikely to present problems due to leachable elements. This question was tackled in depth at the GERPAC conference and will be described in HPE 85. There is a lot to think about, and these issues underline the importance of a sound knowledge of pharmaceutical science to underpin safe and effective use of medicines.
The quest for evidence-based sustainable services has been given a boost by publication of a report from East Lancashire (see page 35). In an echo of the landmark integrated medicines management project (IMMP) in Northern Ireland, the dedicated ward pharmacy project (DWP) has put pharmacist-technician teams on wards and started to yield some impressive results. The pharmacists are prescribers and the hospital benefits from the Refer-to-Pharmacy scheme that allows direct electronic referral of patients, including copies of discharge letters, to community pharmacies.
In the early stages, this scheme appears to have reduced readmission rates and length of stay. It has certainly reduced the costs of medicines and has enabled patients to leave the hospital earlier in the day. In order to achieve these gains, pharmacists and technicians have had to learn new skills and different ways of working. The result is a service that is better aligned to current expectations and the needs of the local
What does this mean for pharmacy? In future the products that pharmacies supply and the way pharmacies work will be different. New products and services will need to be evaluated and new skills learned. Reports of research and practice development projects are critical in providing the evidence to support the transformation process and the implementation of sustainable services.