Pills and potions are much more than products; they are an integral part of patient care and patient safety.
For several years Waikato Hospital Pharmacy has overseen a programme to improve the quality, safety and efficiency of medication services at all Waikato DHB hospitals.
On Tuesday 10 February one of the last pieces in a complex puzzle slid into place when Pharmacy started taking responsibility for the supply of medications to all wards and departments.
Back in 2000 the “supply chain” of ordering, packing and distributing medications from the wholesaler to hospital departments was transferred from in-house to a private company to try to streamline the system and make it cost effective and timely.
While it achieved those aims, the supply chain approach has treated medications more as a product rather than an area of specific expertise.
And that’s where the pharmacy programme comes in.
The programme identified opportunities along the supply chain for adding expert pharmacist input, especially at the points where medications are stored, selected and distributed to the ward.
Pharmacy manager Jan Goddard says the end result maintains efficiency but brings in a quality control and patient safety focus, and stronger Pharmacy support for clinicians.
“What we have done is mainly behind the scenes but it is extremely valuable in improving patient care,” she says. “We have increased the profile of Pharmacy within all Waikato DHB hospitals and promoted the availability of Pharmacy staff to support clinical staff and see patients.
“The DHB has recognised and supported this development,” she adds.
The project aims were better clinical service, medication safety, improved response times, medication security, legislative compliance, and working closely with Pharmac to implement the national Medicines List.
Supporting the project were senior clinician John Barnard and group manager clinical support services Melinda Ch’ng.
Beefing up the role of Pharmacy in medication management has seen the team of experts grow from around 18 fulltime roles in 2005 to 55 today. These include pharmacists, pharmacist assistants and pharmacy technicians.
“This increase means we can be involved in a lot more activity now that directly supports patient care,” Jan Goddard says. A cytotoxic compounding and dispensing service means the Pharmacy orders and prepares drugs for chemotherapy infusion. Another initiative is the development of a chronic care pharmacy team who provide expert advice on medications for patients with chronic conditions.
The Pharmacy is now involved in more clinical trials and provides a wider range of services on the wards and in liaison with community pharmacists. It is also part of a wider Midland health region e-pharmacy project for a shared inpatient pharmacy IT system.
Automated medication dispense cabinets on some wards is yet another way Pharmacy has reshaped its service. Cabinets are now in place in high use areas – Intensive Care, CathLab, three of the four acute medical wards, Older Persons and Rehabilitation wards, and Emergency Department. The system is linked to the hospital’s i.PM patient management system. An authorised nurse logs in, selects the correct patient, searches for the medication type and identifies the dose and formulation required. Once entered on the PC, the system automatically opens the cabinet drawer containing the correct medication.
Looking back over the Pharmacy’s service development Jan Goddard says: “It has been a lot of hard work, involving a huge effort from dedicated Pharmacy staff, but well worth it to know a patient’s medication requirements and clinical safety are much improved.
“This isn’t the end of the journey,” she adds. “There is a lot we can learn from other hospitals here and overseas that will add even more to our services.”