Collaborative working with other health services

Pharmacy type

Community

Pharmacy context

​The pharmacy was a ‘Healthy Living Pharmacy’ co-located with a doctor’s surgery dispensing over 20,000 NHS prescription items each month.  10% of these were acute ‘walk-in’ patients and half were assembled into monitored dosage systems (MDS) for domiciliary patients.  Advanced and enhanced NHS services offered by the pharmacy were medicine use reviews (MURs), new medicine service (NMS), sexual health, supervised consumption of methadone and buprenorphine, smoking cessation (nicotine replacement), weight management scheme, alcohol awareness scheme and seasonal ‘flu vaccinations. 

Relevant standards

• 1.1 - The risks associated with providing pharmacy services are identified and managed
• 1.2 - The safety and quality of pharmacy services are regularly reviewed and monitored
• 4.2 - Pharmacy services are managed and delivered safely and effectively

Why this is notable practice

Integrated governance procedures are in place which improve patient outcomes and patient safety. Collaborative procedures are in place with other healthcare providers and wider community groups. The pharmacy had a strong focus on medicines optimisation and proactively identified and managed potential risks to patients.

How the pharmacy did this

The pharmacy operated in an innovative way to improve patient outcomes through a highly integrated approach with the adjacent surgery. It had been recognised for its approach to medicines optimisation.

Collaborative meetings with the surgery have identified joint areas that meet the wider needs of the local population, outside of the normal scope of pharmacy, such as identifying patients at risk of stroke, Type II diabetes and chronic obstructive pulmonary disease. The pharmacist had an agreement with the surgery to access patient records in its electronic system. He routinely sent a message to the doctor of any patient that he had concerns about, with the prior consent of the patient. There was also a direct referral scheme with the surgery with two appointments reserved each day for patients. One such appointment had subsequently led to a diagnosis of deep vein thrombosis.

A partnership had been established with the Young Carers Association which enabled carers under the age of 16, looking after a parent, to safely collect their parent's medicines from all the local surgeries.

The pharmacy had a printed list of patients who were prescribed high-risk drugs. The pharmacy electronic patient medication record (PMR) had a number of dedicated sections to record any issues, such as safeguarding or non-adherence concerns. Dedicated notes were used to highlight any issues identified on prescriptions that requiring counselling by the pharmacist, such as change in doses or new drugs.

With regard to general pharmacy procedures, there were few dispensing errors and near misses considering the large volume of prescriptions dispensed. These were recorded, reviewed and appropriately managed. The pharmacy had four tablet computers and these were used by the staff member responsible for the mistake to record any near misses. This encouraged learning from self-reflection. A dedicated programme had been developed with drop-down boxes to record the stage the error occurred, the type of error, the time of day, the reason and actions taken to prevent a recurrence. The mistakes were discussed at the time and the log was reviewed monthly and quarterly to capture items that may not be regularly prescribed but often incorrectly picked such as omeprazole 40mg. There had been recent errors with combination eye drops such as Azarga and Ganfort. The staff had received additional training on these and all eye drops were now double-checked at the picking stage. All the staff were supported to learn from mistakes.

Agreement had been reached with the surgery for the newly qualified independent prescriber to spend 8 hours each week on asthma consultations. In addition, it had been agreed that patients presenting at the pharmacy for emergency hormonal contraception (EHC) would be encouraged to have prescribed contraceptives. This initiative was designed to optimise use of medicines and improve patient outcomes, while easing pressure on doctors.

The pharmacy ran a medicines optimisation scheme whereby those patients on repeat dispensing were telephoned on day 21 of the month and asked about their medicines. If the pharmacy had to re-set three medicines or re-set one medicine three times, so that they all ran in line, the patients were referred to the doctor. 400 patients had been identified with appropriate action taken.

What difference this made to patients

Services are managed in an innovative and integrated way with the GP surgery which improves outcomes for individual patients, patient groups and the wider public.