Elite hospitals handed contracts to transform ‘special measures’ hospitals. Health Secretary Jeremy Hunt has set out the Government’s plans to help prevent future failures of care and safety at NHS hospitals. In the wake of the scandal over standards at Mid Staffordshire NHS Foundation Trust and subsequent Keogh Review which looked at 14 NHS Trusts with high mortality rates, 11 of those Trusts have already been placed in ‘special measures’.Now, the Health Secretary has set out a new approach to ensure progress at those NHS Trusts, which could be applied to any NHS Trust that is placed in special measures under a new, tougher inspection regime. Click for more.
RPS has jointly published with the NHS, Best Practice Standards for Managing Medicines Shortages in Secondary Care in England. The Standards provide advice to NHS hospitals in managing medicines shortages at local level to minimise any risks to patients through delays to treatment.Aimed at all staff, particularly Chief Pharmacists, the standards outline guiding principles including collaborative working to ensure that medicines in short supply are used for patients with greatest clinical need. Steps suggested include prohibiting the sale of medicines to third parties or stockpiling by individual Trusts.The document also outlines 13 specific standards on policy, risk assessment and internal processes that should be addressed in order to minimise the effect of medicines shortages on patients.
The hospital pathways programme aims to improve both processes of care and interactions between staff and patients through a collaborative programme involving five acute trusts, the King's Fund and the Health Foundation to apply techniques, not widely used in the NHS. This publication describes the programme; the method used to evaluate it; what was learned about the approach, and how the lessons have influenced the next programme called patient and family-centred care.
Dr Foster’s 2012 Hospital Guide reveals the quality of care provided in the NHS and rates trusts on clinical efficiency for the first time.
Describes a number of improvement projects aimed to help optimise patient care at Central Manchester University Hospitals NHS Foundation Trust, including a recycling initiative, provision of a pre-op pharmacist for patients scheduled for elective surgery, a night shift for the pharmacy stores and logistics operation, an improved waitiing experience in the paediatric outpatient pharmacy, provision of appropriate information for patients attending the eye hospital, etc. For further information click on this link
This report compares expenditure between primary and secondary care in total and for selected areas, including medicines positively appraised by NICE. The specific area covered this year is AIDS/HIV.
Key Facts: In 2011 hospital use accounted for 33.3 per cent of the total cost, up from 31.79 percent in 2010. The cost of medicines rose by 1.9 per cent overall but by 6.9 per cent in hospitals. Of the drugs positively appraised by NICE, the greatest overall cost was for atorvastatin but adalimumab incurred the greatest cost in hospitals. HIV/AIDS treatment is given predominantly through hospitals but while the total cost varies widely, cost per patient is similar. Total prescribing costs in 2011 were £13.1 billion.
This articles describes a quality improvement project at Musgrove ParkHospital (Taunton and Somerset NHS Foundation Trust) applying 'lean' change management techniques to all processes relating to chemotherapy prescribing, production and administration. The resulting changes reduced production run times and patient waiting times, and also reduced staff costs in the chemotherapy unit. For further information click on this link
Currently there are no national guidelines in the UK describing how medicine shortages should be managed in hospitals and relatively few NHS hospitals have a locally developed formal written procedure in place. This article describes how a failure modes and effects analysis (FMEA) identified critical steps in ensuring patient safety when managing medicines shortages in hospitals. Although it is often not possible to predict when medicine shortages will occur, effective processes for dealing with them and communicating internally and externally can be defined beforehand and will help minimise risks to patients. For further information click on PJ Online website
RPS has launched new Professional Standards for Hospital Pharmacy Services: Optimising patient outcomes from medicines. The standards have been developed by a wide range of stakeholders across GB and covers pharmacy services delivered by acute, mental health, private and community service providers.
The 10 overarching standards underpin patient experience and the safe, effective management of medicines within and across organisations. They will enable patients to experience a consistent quality of service within and across healthcare providers, that helps protect them from incidents of avoidable harm and enables them to get the best outcomes from their medicines.
The standards will help organisations to ensure their patients receive a consistent quality of service, regardless of where they receive care that helps protect them from avoidable harm and enables them to get the best outcomes from their medicines. It will support chief pharmacists to lead on medicines safety and use in their organisation and provide a framework for the application of professional standards in hospital pharmacy.”
RPS is currently working with a number of development sites across Great Britain to collect data on the use of the standards in practice, to help refine the standards and develop further supporting tools.
The creation of a consistent approach to hospital pharmacy standards from the professional body supports the driver to achieve the highest quality of pharmacy service focussed on Patient Safety and should be welcomed and embraced. These standards have been developed by the profession for the profession, with input from a large number of pharmacy and multidisciplinary organisations across hospital services. The launch of the standards is the culmination of this work and demonstrates strong leadership from the RPS.
The RPS has published a range of supporting resources that include Handbook, FAQs, Executive briefing, and Presentation, alongside the standards to help support implementation. More information about the standards, supporting resources, and the implementation programme visit our website.
Hospital pharmacy departments have sought a number of innovative ways to deal with the current financial pressures. Outpatient dispensing (OPD) has been one service where different models have been introduced in recent years and the rate of introduction of new services is increasing rapidly. The models include contracting out the OPD to a third party private provider; creating a limited company (a wholly owned subsidiary) which is associated with the Trust; using a social enterprise scheme; and increased use of homecare to cover the majority of OPD expenditure. They all have a common element which seeks to take advantage of the fact that outsourcing the provision of hospital pharmacy OPD allows medicines dispensed by the outsourced provider to be exempt from Value Added Tax (VAT). However, the impact on patient care, organisational benefits and any issues arising from each of the different types of service models has yet to be fully assessed. The PDIG (GHP specialist interest group) committee therefore decided to commission a study to compare the different models and assess the potential strategic impact on other hospital pharmacy services and medicines procurement and distribution. The final report can be accessed by clicking on this Link
Papers on electronic prescribing (computerised prescriber order entry) published in 2011 are summarised in this document under a range of headings: effect on outcomes; effect on medication errors and patient safety; other evaluations; system design; alert presentation; drug interaction processing; other usability aspects; implementation; general and miscellaneous. For further information click on this Link
The standards that care services, including hospitals, have to meet and real examples of how they are met can be found on the Care Quality Commission (CQC) website, which also details how the Commission enforces the following standards.
The Commission has also created a series of booklets to help people understand what they can expect from the care services. For further information click on Link
The Department of Health is asking all NHS acute hospitals to submit results of recent audits of their compliance with published standards for the safe and secure handling of medicines. This is in response to recent concerns about the handling of medicines in hospitals, and to support patient safety. The results of the audits, together with any remedial action plans, should be returned to the Care Quality Commission by 31 March 2012.
See the letter to NHS acute trusts on Medicines security. Download the standards for the safe and secure handling of medicines, published by the Royal Pharmaceutical Society, in The Safe and Secure Handling of Medicines: A Team Approach. In July 2011, Trusts were reminded of the importance of handling and storing medicines in a safe and secure manner.
The Audit Commission and Monitor have jointly published a guide called Delivering Sustainable Cost Improvement Programmes aimed at acute, ambulance, mental health and specialist NHS trusts and foundation trusts. It summarises how successful organisations approach the delivery of cost improvement programmes. NHS organisations have successfully delivered cost improvement programmes for a number of years, but the challenge is getting tougher. The NHS needs to save up to £20 billion by 2015 – which is an average of 5 per cent per year – the biggest efficiency challenge the NHS has ever faced. To succeed NHS organisations will need to radically transform services. For further information click on more.
NPSA20_high_risk_consensus_list_Dec_2011_final_with_feedback.doc is an update on “Examples of risk assessments of injectable medicine products prepared in clinical areas” originally published by the Joint NHS pharmacy technical services groups in 2007. This is not intended to represent a comprehensive list of all potential high risk injectables and does not obviate the need for assessment of local practice, This guidance is intended to assist NHS Trusts to generate their own high risk injectable medicines list for the purposes of implementing the never event policy. Pharmacists are advised to ensure that local risk assessments have been undertaken for the products and miscellaneous groups listed below (if relevant) and any discrepancies in scoring are reviewed.
In this exercise assessment was restricted to routine administration methods for intravenous injections used in the adult setting. These were identified by reviewing risk assessments compiled by Medusa, UCLH, Imperial, Oxford Radcliffe Hospitals and Guys & St Thomas NHS Foundation Trusts and the Pharmaceutical Press, with additional suggestions from members of the working group. The assigned risk levels were agreed through consensus of group members (listed below). Use of injectable medicines in paediatric and neonatal regimens, and by parenteral routes of administration other than IV are not included in the assessment, although the group has included suggested areas of practice in which additional local assessment may be warranted. Where relevant, the availability of commercially available ready-to-use products is highlighted as a means of reducing risk. Additionally aseptic preparation in pharmacy CIVAS services or as a “special” from an alternative provider should be considered as a method of reducing the risk associated with preparing high-risk products in clinical areas. Therapeutic alternatives to high risk products should also be considered as a method of reducing risk in some clinical settings.
The Nuffield Trust has published a review of hospital efficiency which found that there are many ways in which hospitals could improve efficiency and reduce the need for cutbacks in services for patients. It cites length of stay and day surgery rates as examples of where there are still opportunities for efficiency to be improved.
The Pharmaceutical Services Negotiating Committee (PSNC) has worked with NHS Employers to develop and publish guidance on how the New Medicine Service (NMS) and post discharge Medicines Use Reviews (MURs) can be used to provide a seamless care pathway for patients who transfer from hospital to the community setting. The guidance has been endorsed by the by the Royal Pharmaceutical Society (RPS).
Support tools are also available for hospitals and community pharmacists to help formalise how information relating to changes to patients’ prescriptions can be shared. A national referral form has also been developed to support the transfer of patient information between hospitals and community pharmacists. The following documents have also been launched to support this process:
• a template patient information leaflet about the benefits of community pharmacy
• a guidance document for community pharmacy about engaging with hospital colleagues
• a guidance document for hospital colleagues about engaging with community pharmacy
Click on this Press release for further information and access to these documents.