Agenda item

(To receive a report from Colin Costello (Director of Pharmacy and Medicines Optimisation – United Lincolnshire Hospitals NHS Trust (ULHT)) which provides the Committee with details of the processes in place to ensure the delivery of the Hospital Pharmacy Transformation Programme (HPTP) and the commitment of ULHT to redesign infrastructure through the planned implementation of electronic prescribing systems by 2020.  Colin Costello (Director of Pharmacy and Medicines Optimisation – United Lincolnshire Hospitals NHS Trust) will be in attendance for this item)

A report by Colin Costello (Director of Pharmacy and Medicines Optimisation – United Lincolnshire Hospitals NHS Trust (ULHT)) was considered which provided details of the processes in place to ensure the delivery of the Hospital Pharmacy Transformation Programme (HPTP) and the commitment of ULHT to redesign infrastructure through the planned implementation of electronic prescribing systems by 2020.

Colin Costello (Director of Pharmacy and Medicines Optimisation – United Lincolnshire Hospitals NHS Trust (ULHT) was in attendance for this item of business.

The Chairman also welcomed Simon Priestley (Deputy Chief Pharmacists (Clinical Development and Governance) – United Lincolnshire Hospitals NHS Trust (ULHT)) who was in attendance for this item as an observer.

The Committee was advised that robust processes were in place at ULHT to ensure the delivery of the Hospital Pharmacy Transformation Programme (HPTP) which, following The Lord Carter Review, was a requirement of all acute Trusts to have in place by 2017.

A project to deliver the Trust's Constitutional Standards was initiated to improve the way in which discharge prescriptions were managed and to prevent delays in discharge.  This was to change the process to ensure that prescription products were labelled as discharge prescriptions from the point of patient admission, thereby taking the emphasis from supplying patients with prescriptions to take home at the point of discharge.

These products would be held in patient bedside lockers rather than on drug trolleys with any new prescriptions updated ready for discharge at the point of inpatient supply.  The Committee was advised that patient lockers would be locked at all times.  This scheme was referred to as "dispensing for discharge" and was embedded within the HPTP and was to be rolled out across all beds in the Trust, following a successful pilot on ward on Level 6 at Pilgrim Hospital, Boston.

The Trust was investing in new roles for clinical pharmacy technicians to optimise patient medication on the medical admissions wards.  As part of the redesign of roles, clinical pharmacy technicians would administer medication to patients on the ward and help them self-administer, as inpatients.

Further investment was to be made in employing more pharmacist prescribers who would be able to apply expertise in therapeutics and prescribing to optimise evidence-based therapeutic decisions, reduce prescribing errors and reduce delays with discharge prescriptions.  These changes and delivery of further efficiencies within the prescribing process would be supported by a business case, submitted to the Trust, for electronic prescribing and medicines administration (ePMA).  The business case had also been included in the Trust's digital strategy and it was envisaged that the case would be funded and implemented in the 2017/18 funding in line with the requirements of the Carter Review, to ensure implementation by April 2020.

A separate and bespoke ePMA system for cancer patients had been successfully implemented in 2015/16, which enabled improved scheduling of patients, more cost-efficient management of high cost dose-banded cytotoxic chemotherapy and monoclonal antibodies for the treatment of cancers, thereby leading to fewer delays for patients during their treatment and at discharge.

Members were given the opportunity to ask questions, during which the following points were noted:-

·       Although the Trust did not routinely measure the impact of delayed medication on DTOC figures, processes had been implemented to reduce and to further look at the provision of rapid discharge;

·       Delays with providing medication on discharge were often as a result of waiting for a clinical decision to be made by the patient's consultant or doctor.  This was rarely conferred to the patient and therefore the perception was that the delay was with the pharmacist.  Although date of discharge may be known and medication available ready for discharge, the consultant medical team had the final decision and would have knowledge to inform that decision which would no necessarily be available to the wider health care team;

At 12.45pm, Dr B Wookey left and did not return.

·       Concern remained that the planned date of discharge was not usually the actual date of discharge.  Modernisation of an old fashioned system was underway and the issues faces were known as well as required improvements from the pilots.  It was acknowledged that this was to be factored in to the transformation programme but that there were a lot of complex factors to be considered;

·       Self-medication had not yet been implemented but this option would be dependent on the patient and if they felt comfortable to self-medicate;

·       One month of medication was routinely dispensed at the point of admissions.  Pharmacy Technicians would then check the lockers on a daily basis for stock management.  This was part of the Waste Management Programme and was saving approximately £60k per month as a result of recycling unused medication;

·       The Committee was reassured that the competency levels of pharmacists and pharmacy technicians was high level and robust.  Pharmacists must complete a Masters Degree and then a further diploma before they are able to enrol on to a prescribing programme.  The School of Pharmacy at Lincoln University ran an accredited programme through the General Pharmaceutical Council (GPC);

The Chairman advised the Committee that an update to the report had been received prior to the meeting which addressed many of the questions raised.  The Health Scrutiny Officer would be asked to circulate this update to the Committee following the meeting.

The Committee was not fully reassured that the Trust was making every effort to avoid delayed discharges as a result of the prescribing processes and therefore requested that an update report be added to the Work Programme for consideration in September 2016.

RESOLVED

1.    That the report and comments be noted; and

2.    That an update report be added to the Work Programme for September 2016.

At 1.15pm, Councillors D P Bond and Mrs P F Watson left and did not return.