Setting the standard

Many areas of healthcare have written standards and now hospital pharmacy is one of them. In July 2012, the Royal Pharmaceutical Society in Great Britain published its professional standards for hospital pharmacy services, and this represents a landmark for the profession of pharmacy in Great Britain. It is significant that the second part of the title is ‘Optimising patient outcomes from medicines’, clearly identifying the purpose of the hospital pharmacy service in terms of patient care rather than in terms of service delivery. Moreover, it is apparent that these standards are clearly about delivering an excellent,

up-to-date hospital pharmacy service and not about establishing hospital pharmacy as a specialty.

The standards comprise ten overarching standards covering three domains:

• patient experience,
• safe and effective use of medicines, and
• delivering the service.

Each standard is then broken down into its component dimensions and then activities or services are described in concise statements. The standards have been designed to help ensure that patients are protected from incidents of avoidable harm and get the best outcomes from their medicines.

This document will serve two key purposes. It describes to those outside pharmacy – patients and those who commission or pay for the services – what can be expected of an up-to-date hospital pharmacy. It also provides to those inside pharmacy – managers of the service and those who make up the workforce – a framework that allows them to recognise, develop and deliver the best possible outcomes for patients from pharmacy services.

A detailed handbook has been published to provide background information and supporting material for those involved in implementing the standards.

For progressive hospital pharmacy departments, the standards probably do no more than codify what was happening anyway. For those who are not quite at the cutting edge, it must be hoped that the standards will provide a lever to help to focus and develop services in line with current expectations. It is a document that should not be dismissed, for it signals a profession that is sufficiently confident in its role to be able to assert its accountability for patient outcomes arising from pharmacological treatment.

There are many good things in the document but two basic elements stand out at first reading. One standard is devoted to safe use of medicines and this emphasises the organisational focus of medicines’ safety, setting out the requirements for both safe systems and a safety culture, and emphasising the key role of the chief pharmacist. Within this section, the simple statement that, “Pharmacists visibly record when they have seen a prescription and assessed it as clinically appropriate for the patient” makes it clear that this is a basic, not-to-be-missed, element of patient care.

What these standards say, loudly and clearly, is that hospital pharmacy is accountable in large measure for the drug treatment that patients receive in hospital, not merely for its delivery but also for its clinical appropriateness. It also has a major role in promoting a safety culture where medication safety is not an optional add-on but is embedded in the fabric of the organisation. These are not light expectations but we are confident that hospital pharmacists can, and will, meet them.