BSc MSc PhD FRPharmS FCPP(Hon)
The ESCP congress in Lyon, last October, provided some time for reflection on pharmacy and healthcare in Europe. Conferences are always good for reminding you that there may be better ways of tackling a problem or managing a service than those that you know – and so it was in Lyon.
In the first plenary session, which was devoted to stroke management, we were told eligibility for acute thrombolysis for a stroke was 6% in Germany, 1% in France and 0.1% in the UK. Good news for Germans, less good for the French and dismal for the British. This wide variation has stuck uncomfortably in my mind because we (in the UK) are frequently told by our politicians that the NHS is the best service in the world, free at the point of delivery etc etc. Moreover, the recent television FAST (face, speech, arms, time) campaign to help us all to recognise a stroke had led me to believe that the best possible treatment would be available. Admittedly the adverts did not say this – but why would there be a big TV campaign if not? What did I learn from this? Well, one thing that conferences can do is alert us to things that might be less than perfect so that we can start to ask questions back at home.
On the positive side – the way in which electronic communications are revolutionising pharmacy is a dream come true for many of us.
At a robotics conference (see Robotics 2010 report, page 16) we got a much more encouraging vision of the near future from Scotland. The new Forth Valley hospital is apparently equipped with real electronic wizardry. Automated guided vehicles – robots that trundle round the hospital fetching and carrying laundry, food and other items – are the most appealing. All this they do discreetly in their own service passages and tunnels so they are not sweeping down corridors pushing visitors out of lifts or jamming the corridors. Soon they might be delivering bulk fluids and ward boxes, we were told – then they will need some loading-up and putting-away androids. Maybe in future they could move patients too . . . the possibilities are endless.
However, the real gem of this session was to hear how electronic prescribing and medicines management have been integrated so that medicines reconciliation is done for 90% of patients within 24 hours of admission and electronic discharge summaries are sent to GPs and pharmacies with six hours of discharge. This is real progress – underlined by the observation that discharge prescriptions contain fewer items are because of the comprehensive medicines reconciliation – something many of us suspected would happen but could not demonstrate.
It is interesting also to reflect how when pharmacists took drug histories and called it ‘sorting out patients’ medicines’ it remained a rather unsexy thing to do. Now it is called ‘medicines’ reconciliation’ it has become respectable and important.
I think there are two important messages buried in here. First, if an activity is really important it has to be done for all patients as a routine not just for a few when it is convenient. And second, it needs to be described in terms that everyone else (hospital managers, nurses, doctors, patients) can understand.