other settings in the UK was explored in a validation study . 12
With expert consensus as the explicit source of the activity standard in WISN , a two-round Delphi consensus study was run . Hospital pharmacy managers from across Great Britain responded . The ‘ activity standard ’, as identified in Stoke-on- Trent was confirmed by strong consensus of national peers for its application to acute hospital inpatients and the tool was demonstrated to be used reliably by multiple operators . A small number of pharmacy managers in community and mental health settings also responded to the study . Their numbers were not large enough to generate a consensus view on pharmacy activity in these different environments , though the small amount of data provided suggested there would be some differences in the activity standard , driven by tasks mandated in the Mental Health Act , 13 or lower patient pharmaceutical acuity .
The study delivered on its objectives of confirming the activity standard for in-patient clinical pharmacy services in the UK , and therefore the validity of the calculator based on this algorithm and the transferability of the tool between operators . The application of the WISN approach to identifying staffing requirements to hospital pharmacy has proved a methodology which could be adapted to a variety of pharmacy services . Leaders in different settings , or with more specialist patient needs , could replicate this approach to confirm their activity standard and develop a standardised algorithm for identifying pharmacy staff resource requirements .
Reality of practice As with much research , the study generated further questions that remain unanswered and warrant further investigation .
The strength of the consensus with which the ‘ activity standard ’ was confirmed suggests that many hospital pharmacy services are established to deliver the same set
TABLE 1
Comparison of workforce requirements from recent literature
Reference source
O ’ Leary , Stuchbery and Taylor 14 ( average hospital-wide , average LOS 6 days )
Onatade , Miller and Sanghera 15 ( average across seven London sites )
NHS Benchmarking 6 43
CPWC ( 24-bed ward , LOS 6 days , 5 day service ) 12 22
Beds / WTE pharmacist
19.5
18.19
of care tasks for their patients . However , in reality , this will simply not be possible for all patients , given the range of staffing levels available to deliver these services . NHS benchmarking data ( Figure 2 ) 6 suggest that the average number of patients reviewed by each pharmacist each day is 55 , whereas the ‘ activity standard ’, strongly confirmed by the consensus , would suggest that this number should be nearer to 17 . This lower value is supported by other studies ( see Table 1 ). 14 , 15 Patient care cannot , therefore , be equivalent . The first set of questions raised here is to what extent does the activity standard described impact positively on patient outcomes ? Is the evidence base that drives this consensus still valid ? It should be noted that in the survey of hospital pharmacy conducted by the European Association of Hospital Pharmacists in 2010 , UK hospital pharmacist staffing levels
FIGURE 2
NHS benchmarking data 6
|
2016 mean |
2017 mean |
2018 mean |
Hours spend on wards per week by pharmacists per 100 beds |
68.0 |
77.7 |
74.2 |
Patients seen by all pharmacists on wards per day per 100 beds |
58.3 |
62.9 |
57.0 |
Hours spent on wards per week by pharmacy technicians per 100 beds |
33.2 |
42.0 |
40.9 |
Patients seen by all pharmacy technicians on wards pr day per 100 beds |
26.9 |
37.5 |
31.1 |
GETTY
14 | Issue 100 | hospitalpharmacyeurope . com