HPE 100 – March 2022 | Page 16

one of these ‘ wastes ’. Much of clinical pharmacy could be deemed ‘ waste ’, ¹⁹ and where there is insufficient staffing that valuable commodity could be better used by supporting the ‘ getting it right first time ’ ( GIRFT ) approach . The National Institute for Health and Care Excellence guidance on medicines optimisation , which superseded the original medicines reconciliation guidance , requires medicines to be reconciled but does not specify it as a pharmacy role . ²⁰ Should the profession be driving better use of technology and different use of staff to support this GIRFT agenda and release our time to support the active prescribing agenda , rather than correcting the transcription of medicines on admission and discharge ?

More recently , the evidence base describing patient outcomes related to pharmaceutical care is in the area of pharmacist attendance on ward rounds . ^{21 – 23} The work of Gray et al describes the deployment of individual pharmacists to single dedicated wards , facilitating the attendance on ward rounds and with time spent afterwards on the ward communicating medicines related information for onward patient care . ²¹ This service demonstrated associations with earlier in the day discharge , reduced length of stay and reduced readmission rates . In the critical care specialty , the PROTECTED study ²² also highlighted the impact of pharmacists attending ward rounds and the subsequent paper ²³ identified that many sites were not staffed to the recommended levels to facilitate this level of service delivery . In Australia , further evidence supporting this approach was published last year . ²⁴ Is this an additional task to add to the activity standard ? Or is it simply a different way to deploy staff to deliver the same tasks ? If the wards at the hospital in the paper by Gray et al are applied to the CPWC , the staff resource identified is 1.2 pharmacists per ward ( accounting for the unavailable time ); this matches the resource requirement used by Gray et al – and does the staff deployment in this way address the GIRFT issues , complete the task list , and allow extension of tasks due to time released to care from GIRFT ?

Next steps The study by Bednall et al ¹² demonstrated the practicality of standardising the identification of evidence-based staffing levels for pharmacy services , which can be applied to different settings and services internationally . As a profession we should come in line with other health professions in identifying the required staffing levels for our service to remove unwarranted variation . To do so , we need to confirm the ‘ activity standard ’ for our services ensuring that quality outcomes for our patients are maintained . Where staffing levels cannot be achieved using existing pharmacist workforce , perhaps we need to consider changing the scope of practice for our supporting staff groups such as pharmacy technicians .

Conclusion The challenge for the pharmacy profession is to be agile enough to adapt our service model and staffing approach to deliver efficient care , moving away from traditional models of dispensary-based roles or peripatetic lone practitioners , correcting mistakes to a more holistic and MDT approach to care supporting other practitioners in the GIRFT agenda . We need to describe these activities clearly and staff them appropriately – and develop the evidence base that demonstrates the value added to patient care by high quality pharmacy services .

KEY POINTS

• A methodology for identifying pharmacy staffing levels has been proved .

• Staffing levels do not match theoretical levels in practice and the implications of this on patient care is not known .

• The evidence base of the benefit of clinical pharmacy is dated and needs . refreshing to understand the current impact of clinical service models .

• If the activity standard for the profession is confirmed through new evidence , there is insufficient capacity in current staffing to provide these services and up-skilling the pharmacy technician workforce will be necessary .

• Pharmacy needs to be agile in adopting new service models based firmly in the multi-disciplinary team to best serve our patients .

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