The role of the pharmacist in delivering
thromboprophylaxis
Robin Offord
Director of Clinical Pharmacy
UCL Hospitals NHS Foundation Trust
robin.offord@uclh.nhs.uk
The Pharmacy Department
Medicines
Information
Medication
Safety
Production &
Manufacturing
Clinical
Clinical
Pharmacy
Pharmacy
Quality
Assurance
Formulary &
Medicines
Management
Procurement
Dispensing
& Distribution
Clinical Pharmacists – Back Office Functions
Clinical Governance
& Risk Management
Financial Governance
& Risk Management
Education
& Development
Management
& Leadership
Medicines
Management
(Multiprofessional)
Guidelines, Policies,
& Protocols
Expenditure Reports
& Analysis
Under- & PostGraduate Teaching
Strategic Vision
& Direction
Formulary
Evaluation
& Audit
Commissioning
Competence Assessment
& Peer Review
HR, Employee Relations,
& Recruitment
Safe & Secure
Handling
Research
& Research Support
QIPP
eLearning
Project
Management
Quality
Assurance
EQUIP study
• 19 acute hospital trusts in North-west England
• 11,077 errors were detected in 124,260 medication orders
– Drug charts checked on seven consecutive ‘census days’
• 8.9 errors for every 100 prescriptions ordered
Recommendations
Re-evaluate
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Clinical working environments
Undergraduate medical education programmes
Foundation Year 1 education
Other parts of the medical education continuum
Interprofessional education
Dornan T, et al.
http://www.gmc-uk.org/about/research/research_commissioned.asp
UCLH study in acute medical admissions
Methodology notes
• Errors identified by prescribing doctor, pharmacist or auditor
• Graded as per EQUIP study by independent doctor and pharmacist
• Excluded iv fluids, stat and VTE prophylaxis sections of the chart
Results
• 121 errors identified in 1,067 medication orders audited (11.3%)
– EQUIP study reported an error rate of 13.4% for new admissions
• 3% of errors recognised by doctor
• 63% by pharmacist
• 34% by auditor
Clinical Pharmacists – Care bundle approach
Medicines are accurately
transcribed on
admission and discharge
Medicines
Reconciliation
Patients are satisfied
with information
about their medicines
Medicines are
safe and effective
Medication
Review
Timely
Supply
Patients receive the
correct medicines
in a timely manner
Provision of
Patient
Information
Safe
Discharge
Duncan McRobbie
Guy’s & St Thomas’ Hospitals NHS Foundation Trust
Additional benefits
• Depth and breadth of service provision
– Generally, all inpatients are seen every day
– Increasing levels of service to Pre-Admission Clinics
• Strong working relationships
– Accepted role in influencing and leading on prescribing decisions
• Continuity
– High levels of turnover
• Impact of European Working Time Directive – Shift working
• Short junior doctor rotations
• Prescribing functions
VTE CQUIN Actions
Clinical Governance
& Risk Management
Financial Governance
& Risk Management
Education
& Development
Management
& Leadership
Medicines
Management
(Multiprofessional)
Guidelines, Policies,
& Protocols
Expenditure Reports
& Analysis
Under- & PostGraduate Teaching
Strategic Vision
& Direction
Formulary
Evaluation
& Audit
Commissioning
Competence Assessment
& Peer Review
HR, Employee Relations,
& Recruitment
Safe & Secure
Handling
Research
& Research Support
QIPP
eLearning
Project
Management
Quality
Assurance
VTE CQUIN Actions
VTE Risk Assessment
& Appropriate Action
Medicines are accurately
transcribed on
admission and discharge
Medicines
Reconciliation
Patients are satisfied
with information
about their medicines
Medicines are
safe and effective
Medication
Review
Timely
Supply
Provision of
Patient
Information
Patients receive the
correct medicine
in a timely manner
Safe
Discharge
Pharmacy – CQUIN implementation in 2011-12
VTE Risk Assessment
& Appropriate Action
Thrombosis Committees
- Evidence-based guidance covering all clinical specialities
- Trust-wide awareness and education programme
- Regular audits of progress
- Electronic solutions for data capture
Guidance
Comprehensive clinical guidelines
Online training and assessment tools
Implementation
Modified drug charts to aid appropriate prescribing
Evaluation
Audits by ward pharmacists at appropriate frequencies
Performance reported via quality scorecards
Future development
Incorporate appropriate rules into ePrescribing solutions
The Pharmacy Profession
• Separation of regulatory and leadership functions in 2010:
Multidisciplinary, multiprofessional approach
• Shared core values
– Make the patient the focus of everything that we do
– Support our staff to deliver the best care that they can
– Ensure best value in health care
• Collaboration
– Yields benefits greater than the sum of the individual contributions
VTE Three Professions Group
National VTE Prevention Programme
SENIOR RESPONSIBLE OWNER
(SRO)
Sir Bruce Keogh
NHS MD
VTE BOARD (~15 people)
Dr Anita Thomas OBE (Chair)
NCD for VTE
CLINICAL ADVISORY GROUP (~25 people)
Dr Anita Thomas OBE (Chair)
DH INTERNAL STAKEHOLDER GROUP
Tim Brown
VTE PREVENTION TEAM
Margaret Candeland (0.3 WTE)
Workstreams
Patient
Awareness &
Experience
Beverly Hunt
Sally Brearley
Professional
Leadership
AoMRC
External Reference Groups
VTE THREE PROFESSIONS GROUP
Rotating Chair:
AoMRC; RCN; RPS
PREVENTION AND PH
[QIPP / CQUIN]
Measurement &
Evaluation
Anita Thomas
Tim Brown
Information &
Audit
Anita Thomas
Tim Brown
Communications
Michael Carden
Janine Ford
VTE Prevention Action Plan
• Royal Pharmaceutical Society working with
UK Clinical Pharmacists Association HAT Group
• Liaison with other professions to align actions
• Announcement at VTE Prevention Leadership Summit – 30 March 2011
– Sir Bruce Keogh - NHS Medical Director
– Andrew Gwynne MP - APPTG Chair
– Rt Hon Andrew Lansley CBE MP - Secretary of State for Health