HPE 100 – March 2022 | Page 15

were around three-times higher than in other European countries . 16 The same challenge is raised – what is the difference in impact on patient care ?
Clinical pharmacy – validity of the evidence base The activity standard , as confirmed by the consensus , is largely driven by the medicines reconciliation work stream , which is heavily evidenced-based 2 and monitored throughout the NHS . 5 Medicines reconciliation , i . e . the confirmation of the complete list of medicines prescribed for and taken by a patient prior to their admission to a new health care setting , contributes to the majority of the staff time requirement for the delivery pharmaceutical care . This evidence strongly associated the reconciliation of patients ’ medicines at transfer of care ( particularly around admission to hospital ) with improved patient outcomes . As staffing levels vary greatly , the same level of medicines reconciliation cannot be delivered consistently between sites and so the assumption might be that there are differences in patient outcomes which would impact on equity of care . Some components of the task must be omitted for some or all patients . Which of these are relevant in terms of impact on outcome presuming the patient cohorts are similar ? In addition , much of this evidence base is 15 years old and technology advances in that time might have impacted on the association between medicines reconciliation and positive patient outcomes . Reasons for this may include the reduced need for the process of medicines reconciliation as the technology has driven accuracy of data transfer between care settings or technology has reduced the time it takes to complete medicines reconciliation . The activity standard would need to be adjusted in both scenarios . However , the evidence base that drives this activity and its associated time requires refreshing to confirm the previously identified impact .
This is necessary if we are to continue to deliver evidencebased care at the appropriate level for our patients . The staffing levels , calculated by the CPWC , driven by evidence , are more than the average seen across the UK . If adopted widely this increased requirement for pharmacist and pharmacy technician resource is identified at a time when there are substantial competing employers for this workforce within the UK .
Pharmacy technicians If we are unable to staff to the identified ‘ activity standard ’ with pharmacists , do we need to consider the skill mix of the team delivering the service ? An area of practice where consensus was difficult to achieve related to the interim review of patients between admission and discharge . At present the activity standard suggests that this should be done by pharmacists . In the UK , delivery of pharmaceutical care is already supported by registered pharmacy technicians . These vocationally trained staff support many elements of the medicines supply process and have developed a strong role within medicines reconciliation activities . Perhaps the role of the ‘ clinical ’ pharmacy technician needs to be considered here ? The team at Royal Stoke University Hospital explored this question in an assessment of pharmacy technician clinical skills . The team of medicines management technicians at the Trust were asked to review a prescription chart to identify medicines management issues and the necessary action required to ensure the safe use of medicines . The same prescription was used as a clinical assessment of pharmacists presenting for interview for entry grade posts . The results were marked and ranked in order of success ( see Table 2 ). The highlighted candidates were the pharmacist interviewees .
TABLE 2
Comparative results of clinical assessments of pharmacy technicians and junior pharmacists
Candidate number Total score %
CH03 33 97.06 %
RS09 31.5 92.65 %
RS06 31.5 92.65
CH08 29 85.29 %
RS08 28.5 83.29 %
RS01 27 79.41 %
B602 25 73.53 %
RS03 24.5 72.06 %
CH04 24.5 72.06 %
RS07 24 70.59 %
CH02 24 67.65 %
B605 23 64.75 %
B601 22 64.71 %
CH06 20.5 60.29 %
B603 20 58.82 %
B604 19 55.88 %
RS05 17.5 51.47 %
RS04 16.5 48.53 %
CH07 15 44.12 %
CH05 12.5 36.76 %
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As an ‘ in-house ’ exploration of the issue this was not subject to statistical analysis , but the data is shared for illustrative purposes .
This data demonstrated that the existing clinical knowledge of these medicines management technicians ‘ compared favourably ’ to the junior pharmacist cohort . These results were replicated in West Midlands study from Aston University in the UK . 17 Service structures that support the extension of practice of this workforce should be considered and the activity standard could then be adapted accordingly .
Alternatively , time could be released to care by making the approach to service delivery more efficient . In the field of continuous improvement methodology , the basis of the Toyota ‘ Lean ’ system 18 requires the removal of ‘ waste ’; repetition of activities not done to the correct standard the first time is
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