Dedicated pharmacy service in critical care shows significant impact

Context

Standards exist for pharmacy support within critical care and it is mandated that these are met by 2026. A dedicated ward pharmacy (DWP) service was implemented within Northampton General Hospital Critical Care Unit to meet the standards, and the benefits of this new service were assessed.

Problem

Insufficient pharmacist and pharmacy technician support meant that it was not possible to attend all weekday ward-rounds and provide optimum pharmaceutical care for all patients.

Intervention

A gap analysis against standards was conducted. Pharmacy and critical care staff were made aware of the need for improvement and agreed with the proposed plan to implement DWP. A dedicated team of pharmacists and pharmacy technicians was recruited to meet the standards. Funding for additional staffing was obtained through a business case, following a successful pilot of DWP in 2020 on two medical wards which demonstrated patient safety benefits. In August 2022, key performance indicators (KPIs) were agreed, and roll out and data collection were planned. A start date of May 2023 was set, after staff recruitment and training. 

Measurement of improvement

Data was collected for medication incident reports, pharmacist ward-round attendance, prescriptions reviewed, and interventions made. Interventions were assessed by pharmacists according to critical medicine involvement in line with Trust policy and the potential to cause harm. Additionally, medicines reconciliations completed by pharmacy technicians were recorded.

Effects of changes

Data was collected between October and December 2023 after DWP implementation and compared to baseline. Critical care staff feedback was also obtained.

• 77% of weekday ward-rounds were attended by pharmacists (baseline 45%)
• 443 prescriptions were reviewed on ward-rounds (baseline 42 – a 955% increase)
• 930 pharmacist interventions were made (baseline 212 – a 339% increase)
• 563 (61%) interventions were completed on ward-rounds (baseline 86 – a 555% increase)
• 277 (30%) interventions involved a critical medicine or moderate-severe harm
• 62% fewer medication incidents were reported
• Pharmacy technicians reviewed 429 more prescriptions (baseline 182 – a 236% increase) and completed 152 medicines reconciliations on admission (baseline 38 – a 300% increase)
• Pharmacy technician support released 7 hours/week for pharmacists (baseline 1.5hrs/week), which was used for a separate quality improvement project to update drug charts with pre-printed infusion prescriptions. This reduced prescribing errors by 97%.
• 100% of critical care staff providing feedback found the additional pharmacy presence helpful, noting improved medication availability and faster resolution of medication queries.

Conclusions

DWP within critical care has significant patient safety benefits. Pharmacist interventions prevented medication errors, reducing harm and potentially length of stay. Additionally, critical care staff benefits were reported. This work strengthens existing evidence and provides new data by quantifying pharmacy technician impact on pharmacist time, critically informing future critical care pharmacy standards. Furthermore, DWP facilitates quality improvement projects which benefit patients and the critical care service as a whole.

 Additional authors: Laura Robinson, Northampton General Hospital NHS Trust

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.