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Medicines management is the new buzzword in pharmacy, particularly in hospitals. In the UK we have had a National Audit Commission report specifically targeted at medicines management in hospitals and, more recently, the Department of Health has issued a performance management framework for medicines management in hospitals. Hospital chief pharmacists are expected to be the medicines management leads for the hospital.
But what is medicines management, and why is it so important? Medicines management can be defined as “influencing the availability and policies on medicines at an organisational level, as well as the prescription, supply and use of medicines at an individual patient level”. The first part of this definition could be described as strategic medicines management, which is focused on influencing the organisation and its use of medicines: for example, how the organisation manages the entry of new medicines. The second part is really operational medicines management, which is focused on how we use medicines at the individual patient level: for example, systems for using patients’ own medicines on admission to hospital. This definition covers nearly everything that hospital pharmacists and support staff do within the organisation and includes the extended roles pharmacy staff undertake outside the department.
So, why should it be important to management that hospitals manage medicines properly? The answer is that medicines represent risks to the organisation, not only in terms of clinical risk, but also in terms of financial risk. It has been estimated that up to 10% of all hospital admissions are medicines-related, and with 7,000 doses administered per day in a typical medium-to-large acute hospital, there are plenty of opportunities for something to go wrong either at the prescribing or at the administration stage. Furthermore, medicines expenditure is approximately 5% of a hospitals total operating budget, which represents a significant financial risk to the organisation. While clinical risk is important, it is my experience that hospital managers tend to become very interested when financial risk is mentioned, and invariably clinical risk also has a financial implication.
Therefore, we need to emphasise these points to senior hospital managers at every opportunity. Hospital pharmacists are at the centre of the medicines management agenda, whether it is at the operational level, helping prescribers and patients get the best out of medicines, or at the strategic level, helping the organisation develop policies and systems to manage medicines effectively. However, hospital managers need to understand how important good medicines management is for their organisation.
We say we are the experts on medicines, but we need to demonstrate that we are also experts at managing these powerful tools and at minimising the associated risks. We need to show how good medicines management benefits the organisation, helping it become more efficient and reducing risk. If we can successfully make these arguments, then medicines management will not be just another piece of healthcare jargon but a vital part of the hospital management system, and it will also secure the hospital pharmacist as a valuable asset to the organisation.
Ray Fitzpatrick, Consultant Editor