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Published on 1 July 2005

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Removal of controlled drugs from pharmacists

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Judith Telford
Aseptic Dispensing Services Manager
Northumbria Healthcare NHS Trust
UK
E:Judith.Telford@northumbria-healthcare.nhs.uk

Hexham General Hospital, the most northerly NHS trust in England, is part of Northumbria Healthcare NHS Trust. Stretching from the banks of the river Tyne in Newcastle, north up to the border with Scotland, the trust serves about 500,000 people.

Hexham General Hospital is one of three district general hospitals in the trust. There has been a hospital in Hexham since the Second World War. The current hospital opened in July 2003 and offers the highest quality of healthcare in a 21st century setting. The new hospital comprises 98 beds, a critical care unit, four operating theatres, a day treatment centre, radiology, casualty, maternity, outpatient and therapies units.

At Hexham General Hospital, all aspects of the handling of controlled drugs have traditionally been undertaken by pharmacists. A project was undertaken to investigate whether pharmacy technicians could take over some of these activities. This would release valuable pharmacist time that could be used to undertake additional ward-based clinical duties.

Aim
The aim of this project was to investigate whether pharmacy technicians and dispensing assistants could undertake some of the activities relating to the supply of controlled drugs previously undertaken solely by pharmacists at the hospital.

Methods
The project started during April 2003. Activities of the handling of controlled drugs to be taken over by pharmacy technicians and dispensing assistants were:

  • Receipt of controlled drugs in the pharmacy department.
  • Making all necessary entries in the controlled-drug registers.
  • Performing a routine ward stock “top-up” of controlled drugs, including ordering for the wards.
  • Supplying and dispensing all controlled drugs, both for ward stock and for individual patient prescriptions.
  • Checking all dispensed controlled drugs by accredited checking technicians.

The first step was to write standard operating procedures and have them adopted. This ensured that all staff were aware of the new working methods and standards. It removed the possibility of any role or method of working being ambiguous and minimised the likelihood of errors occurring.

The pharmacy staff were asked to discuss their training and development needs and also to provide feedback, both good and bad, about the project and their changing roles.

Where new working practices affected other healthcare professionals, such as nurses and porters, they were informed in advance of any changes relevant to them, and were also encouraged to participate in the adoption of changes in working practice and give feedback wherever possible.

In order to check how useful the project had been, a Likert-scale satisfaction questionnaire survey was carried out among the ward and department managers. This also investigated whether the work had had an impact on other healthcare professionals, in addition to pharmacy staff.

Results
The project ran from April to December 2003. Table 1 shows the number of ward issues (not prescriptions) of controlled drugs made to wards and departments between April and December 2003.

[[HPE21_table1_71]]

These results show how issues made by technicians gradually increased over time, and how issues made by pharmacists gradually decreased over the same period. Issues made by pharmacists will never reach zero, as on a few rare occasions during “out of hours” service pharmacists have to issue controlled drugs.

The project highlighted a gap in the training of porters. There was no formal training available relating to the transportation of controlled drugs. A training programme that included practical instruction, background reading and oral questioning was therefore established.

In order to know what others thought about the project, the Likert-scale satisfaction questionnaire survey of the eight ward and department managers involved was carried out. A 100% response rate was achieved. Findings of the questionnaire are shown in Table 2. The responses illustrate the very marked difference in customer satisfaction since the project was completed.

[[HPE21_table2_73]]

Discussion
Before the project began, dissatisfaction with the service was mainly due to order books being in pharmacy too long, or pharmacy being unable to respond to requests for controlled drugs at short notice.

All ward managers are now clearly very satisfied with the service they receive from pharmacy. They were all impressed by the amount of nursing time saved, and all liked the fact that they now do not run out of normally stocked controlled drugs. They also liked how they could still order controlled drugs themselves, although this was rarely necessary.

The advantages of the new working systems introduced as a result of this work are diverse.

To pharmacists:

  • They have extra time to spend on the development of their clinical roles.
  • They are less tied to the pharmacy department.

To the pharmacy department:

  • The controlled-drug orders arrive in the department at a time that is controlled.
  • The orders can be dispensed at a time that is convenient for the department.
  • There are fewer occasions when “dispensing on demand” happens.

To nursing staff:

  • They know that their stocks of controlled drugs are “topped up”, so that there are fewer occasions when stock is not available.
  • They know that the stocks of controlled drugs are monitored for expiry dates, so there is less risk that out-of-date drugs will reach patients.
  • They recognise that the “top-up” service has been introduced to improve the pharmacy service. This has improved relationships between the pharmacy team and ward or department teams.
  • Nursing time previously spent on issues relating to controlled drugs is now available to be spent on patient care.

To the patient:

  • Their doses of controlled drugs are given at the correct time.
  • There are fewer “missed” doses.
  • There is less risk of expired stock being used.

Conclusions
Following the very successful results obtained from this project, all pharmacy technicians and dispensing assistants working at Hexham General Hospital are now trained to handle controlled drugs.

All of the original objectives have been achieved, most notably the release of pharmacist time, allowing the pharmacists an increased input into clinical duties.
The project has significantly impacted on the work of other healthcare professionals. A significant amount of nursing time has been released, time that can be better used on direct patient care. Porters now undergo a structured training programme on the transport of controlled drugs.



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