Implementing a virtual ward pharmacy service: Lessons learnt

In this article, we examine the role of pharmacy in a virtual ward setting, and explore best practice for implementing a virtual ward pharmacy service.

What is a virtual ward?

A virtual ward, or “hospital at home”, allows patients to receive hospital-level care and monitoring in their own homes or familiar settings, using technology and a multidisciplinary clinical team. The goal is to provide safe, efficient, and comfortable care that avoids hospital admissions or enables earlier discharge, speeding up recovery and freeing up hospital beds for those who need them. Care involves regular reviews by healthcare professionals through home visits, video calls, and remote monitoring devices that track vital signs like heart rate and blood pressure.

Virtual ward professional standards

The Royal Pharmaceutical Society has developed professional standards for virtual wards:

• Putting people first
  Patients and carers should be actively involved in care decisions, receive information about medicines, and have opportunities to ask questions. 
• Episode of care
  Pharmacy services must cover the full patient journey—from assessment through to discharge—with clear communications and documentation, including discharge summaries. 
• Integrated transfer of care
  Seamless communication between providers and with patients is essential—particularly around medication reconciliation to prevent disruption or errors. 
• Medicine & pharmacy services governance
  A senior pharmacy lead must be appointed at the outset to oversee design, implementation, governance, and coordination across service sectors (acute, community, primary care). Risk assessments, SOPs, incident reporting, and escalations for deteriorations must be in place.
• Safe & efficient supply of medicines
  Medicines should typically be supplied via individual prescribing, not Patient Group Directions (PGDs), wherever feasible. Proper handling, storage, labelling, and transport (including out-of-hours support) must be ensured.
• Leadership
  The senior pharmacy lead should also steer quality improvement, audit, workforce development, and service supervision.
• Systems of work
  Leverage digital solutions for monitoring, diagnostics, prescribing, and communications—consistently and with consent. Ensure financial planning and governance, and focus efforts on health inequalities, deprescribing, antimicrobial stewardship, and workforce flexibility.
• Workforce
  Virtual ward teams should include a skilled pharmacy workforce, appropriately staffed and supervised by the senior pharmacy lead. Pharmacy professionals should actively participate in multidisciplinary care rounds and patient reviews. Encourage flexible working, rotational roles, and support pharmacists training as prescribers. Patients, carers, and other professionals should also be educated on medicine handling in this setting.

Implementing a virtual ward pharmacy service

In Sussex, virtual wards have been running for over three years in various forms with a significant expansion in bed numbers from Winter 2022. The Sussex virtual wards had pharmacy and medicines management input from the beginning, enabling a strong organised plan to incorporate pharmacy into the multidisciplinary team (MDT).

On reflection, one of the most important parts of the service design was around the supply of medications. Whilst it would have been more straight forward and perhaps more comfortable to use a secondary care or hospital dispensary, the Sussex virtual wards predominantly use the patient’s usual community pharmacy to supply medicines to our patients.

Another important development in the early stages was a system-wide agreement that whilst patients were admitted to the virtual ward, all prescribing would fall to the virtual ward team and the patient’s usual GP would be informed that they would not expect to prescribe for this time period. All medicine changes are then communicated to the usual GP via the virtual ward discharge summary. This has proved invaluable in ensuring the virtual team have oversight and responsibility for all prescribing and prevents duplication.

Developing virtual ward pharmacy roles

It has been important for the virtual ward pharmacy team to have its own leadership and structure to enable consistent cover and a strategic approach to the service offered to patients. The core activities identified and implemented included:

• Medicines reconciliation
• Clinical screening/medication review
• Attendance at MDT
• Support with medicines supply

There has also been strategic input including:

• Design of patient note templates
• Input into virtual ward SOP
• Creation of novel pathways for medicines supply
• The use and supply of intravenous (IV) medicines

Daily responsibilities for a virtual ward pharmacy team

• 8:30am: Pharmacists and pharmacy technicians spend time reviewing patient notes and preparing for the MDT meeting.
• 9:00am-10:30am: Pharmacists and pharmacy technicians attend the MDT meeting, either remotely via MS Teams or in an office base. We have five different virtual wards covering a large geographical area.
• 10:30am-4:30pm: Pharmacy technicians identify any new patients and complete a medicines reconciliation for them all, with added focus on how patients manage their medication at home and how their medication is supplied.

Pharmacists review patient blood tests and clinically screen all patients’ medication, prioritising the new medicines reconciliations, and patients with new blood test results or abnormal observations. All team members have access to online blood results and the remote monitoring dashboard.

Pharmacists and pharmacy technicians follow up any identified supply issues and assist the team in ensuring medications are available to patients. In addition, the team communicate changes to patients and their carers, and liaise with community pharmacies to help arrange supply of medication. In some cases, a member of the team may visit a patient in their own home to provide advice and counselling, or help with organising a patient’s medication and disposing of items no longer needed.

Navigating system changes

The virtual wards in Sussex have been through several structural changes over the last 24 months, with Trust reorganisation and a change in the delivery of the medical model from consultant-led to a GP-led model. This has been unsettling for those working in the pharmacy team, but expected due to the service being new and under development.

In these uncertain times, it has been important for the virtual ward pharmacy team to remain resilient, focus on the established processes and maintain the same level of patient care. Having a patient focus has helped the team to remain consistent in service delivery, but inevitably has delayed progress of some projects and aspirations the team have in terms of development.

Other teams should be prepared for changes especially in new services, and as NHS reform accelerates. Focusing on the care delivered to the patients helps maintain a consistent and equitable service.

What does the future hold for virtual ward pharmacy?

Having prescribing pharmacists has been invaluable in establishing the team within the MDT and supporting with medicines supply. The ambition would be to have all virtual ward pharmacists qualified to prescribe and to explore extending this role.

In the future, the pharmacy team have ambitions to explore how structured medication reviews (SMRs) may be incorporated into virtual ward practice. Patients admitted to the virtual ward because of a fall have been identified as a possible target population for this service.

Best practice tips for implementing a virtual ward pharmacy service

• Ensure there is a robust supply process in place considering the geography of the area covered by the virtual ward.
• Consider the risks associated with duplication of prescribing and mitigate against this.
• Plan to deliver the key roles and responsibilities of a pharmacy team, including medication reconciliation and clinical review of prescribed medication for all patients.
• Utilise all members of the pharmacy team, using a balanced skill mix including pharmacy technicians. All pharmacists and pharmacy technicians within our team are at a senior level; this is deemed necessary due to autonomous working and the skills required to manage a large patient caseload where patients are in their own home. Prioritisation is a key skill identified by all team members as essential.
• Consider expanding and maximising the skills and responsibilities of all staff members to help manage patients in their own homes.
• Consider using remote consultations and utilise available training to make this more successful.

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