The impact of frontloading the provision of patient orientated pharmacy services in the acute medical unit on the same service provision in the first seventy two hours following transfer to a medical ward

Abstract

IntroductionA hospital providing acute medical care to adults is now expected to have an acute medical unit (AMU). This is true of health service systems both in the UK and worldwide. Nationally the AMU is modelled as the hub around which acute medical service provision is provided throughout hospital organisations1. Problems with medicines are recognised as a contributory factor in a significant proportion of acute medical admissions and pharmacy clinical service provision (for example, medicines reconciliation) is acknowledged as being of value in supporting the attainment of optimal service outcomes. There is, however, little published research that looks at how pharmacy services in the AMU are provided. AimsThe programme of work has two aims. The first describes how pharmacy clinical service provision differs between the AMU and the medical wards. The second reports the impact of a front-loaded model of clinical service provision onto the AMU upon the subsequent need for pharmacy clinical service in the first 72 hours following transfer to a medical ward.MethodThis work used a cohort method to capture self-reported clinical service activity by pharmacy staff on the AMU and medical wards over three discrete periods of time. Patients moving from the AMU to the wards during the data collection were further investigated to determine the impact of AMU interventions by pharmacy staff on the subsequent need for similar intervention following ward transfer. ResultsThe data collected successfully demonstrates that there are quantitative differences in the activity content of pharmacy clinical service provision between the AMU and the wards. Differences were seen with regard to a number of different aspects of service provision and also between the activity of pharmacists and pharmacy technicians. Additionally, data collected described differences in workload factors likely to influence the provision of pharmacy clinical services. Front-loading pharmacy services into the AMU is suggested to have advantages in enabling earlier identification of errors, earlier ordering of medicines, earlier medicines reconciliation. This is achieved without increasing the overall time spent upon providing services. This intuitively suggests that medicines use is likely to be safer and more effective across the course of the admission.ConclusionsThe findings of this research suggest that the front-loaded model of care has clinical value for patients in terms of the prompt control of risk without detriment to service provision in terms of increased need for input by pharmacy staff. Service provision differs between the AMU and the wards and an understanding of this variation in the context of clinical workload will inform service design and lead to the implementation of service models equipped to attain required performance levels without creating an unsafe or unnecessarily pressurised working environment.

Date of Award	1 Aug 2016
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Mary Tully (Supervisor) & Justine Scanlan (Supervisor)