Pharmacist in virtual frailty ward significantly impacts patient care

Background

Virtual wards were established by NHS England to provide hospital-level care at home, aiming to alleviate pressure on hospitals. While there is evidence that virtual wards can reduce hospital admissions and facilitate early discharge, there is limited evidence on the specific impact of pharmacists within these setting.

At Newham University Hospital (NUH) the Virtual Frailty Ward (VFW) provides support to elderly patients (≥65 years old) living in Newham, with a Clinical Frailty Score (CSF) ≥5 requiring additional support in the community following discharge from hospital or referred from clinics.

This study aimed to assess the impact of a pharmacist in a VFW setting at NUH to support the continuation of pharmacist involvement in the service.

Objectives

To review the impact of the addition of a pharmacist to a virtual ward service through the number and level of contributions made.

Method

A data collection tool was developed and approved by the wider team. Data was collected over the month of April 2024; all patients admitted onto virtual ward were included.

The VFW pharmacist recorded the number and severity of medical contributions made using the King’s College pharmacy clinical contributions severity rating scale. In addition, the following contributions were also recorded:

• Medicines reconciliation completed within 24 hours
• Number of home visits completed by the pharmacist
• Medication supply
• Discharge Medicines Service (DMS) referral completed

Results

Over the study period of April 2024, a total of 52 patients were admitted to the VFW. A total of 83% of patients (43 out of 52) required pharmacist intervention, with an average of four interventions per patient.

The severity of contributions varied as follows:

• 0 (5%)
• 1 (3%)
• 2 (63%)
• 3 (24%)
• 4 (5%)
• 5 (0%)

Impact on patient care

• 79% (41/52) had their medicines reconciliation completed
• 37% (15/41) completed in 24 hours
• 13% (7/52) of patients were visited in their homes.
• 27 patients required a supply of new or existing medication
• 29 (56%) DMS referrals completed

Conclusion

The inclusion of a pharmacist in the VFW significantly impacted patient care, with 87% of patients requiring some form of intervention. The pharmacist’s role was crucial in preventing medication-related incidents, supporting transition from secondary to primary care, and reducing readmission. As the data was analysed by the pharmacist, limitations such as potential bias can arise, however this study provides valuable insight into the role of pharmacists in virtual wards.

For future work, we will be assessing the timeframe for receiving medication and patient satisfaction with the Electronic Prescription Service (CLEO SOLO). Additionally, we will evaluate the timeframe for medication changes made by the VFW team to be implemented in the community.

Additional authors: Nasira Makan, Barts Health NHS Trust; Abena Addo-Atuah, Newham University Hospital, Plaistow

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.