Title: Developing and assessing the feasibility of a pharmaceutical care complexity screening tool to aid the targeted delivery of patient focussed clinical pharmacy services in hospital
Funder: Department of Health and Social Care

Abstract: Hospital pharmacists play an essential role in patient care, ensuring medicines are used safely and effectively. Pharmacy services attempt to provide a service in which clinical pharmacists review patients daily, Monday to Friday. However, current financial pressures within the NHS means that departments are under pressure to do &ldquo;more for less&rdquo;. Thus, not all patients will be reviewed daily by a pharmacist. This gap in pharmaceutical care provision may not be a problem for some patients but for others it could have deleterious consequences. The ability to accurately screen and identify those patients who need the greatest pharmacy input and those who do not would be of great benefit to patients and hospital pharmacy teams enabling appropriate allocation of costly staff resources. Having pharmacy staff reviewing patients at most risk of harm due to medications, ensuring cost effectiveness of the pharmacy service, has been identified as an important response to current pressures.1 Other healthcare professions, notably nursing, have invested in developing tools that classify the severity of a patient s condition and the intensity of care patients will need.2 These approaches ensure that patients are seen by the right staff with the right skills in the right place.3 There have been attempts within some hospitals to implement locally developed pharmaceutical care screening tools. These have not been methodically formulated for routine use and there is a lack of agreement as to what such a tool should comprise. There are also a small number of international studies that have employed electronic systems to assign pharmaceutical risk. These tools will only operate within hospitals which use electronic records and there is a need to develop an approach for identifying patients pharmaceutical complexity that does not rely on complex algorithms or availability of electronic data and could be widely adopted across the NHS. We will develop a tool, rigorously and systematically, which can be used by the hospital pharmacy team to triage new patient admissions according to the complexity of their likely pharmaceutical needs. The care of the sickest patients and those on combinations of high risk medication (at greatest risk of preventable harm due to medication) will then be seen most quickly by an appropriately experienced clinical pharmacist, targeting the deployment of resource limited clinical pharmacy services. We will conduct our study in three phases. 1) Survey of NHS acute hospital trusts Due to the lack of published work, we will survey all NHS acute hospital pharmacist departments on current deployment approaches for clinical pharmacy services to identify any tools currently in use, to understand current approaches and gain insights into what works and what doesn t. Our findings from this stage will feed into phase 2. 2) Consensus methods to develop a pharmaceutical care complexity screening tool We will run two Delphi techniques with experts, to develop a classification scheme of pharmaceutical complexity and to assign appropriate frequency and competency of clinical pharmacist input for each level of complexity. 3) A feasibility study of a pharmaceutical care complexity screening tool The resultant tool developed from the previous phases will be implemented across two hospitals, to assess its acceptability and inform the design of a future stepped wedge cluster randomised control trial. We believe that a pharmaceutical care complexity screening tool that has been robustly and systematically developed could lead to greater patient-centred pharmaceutical care, improve patient safety and assist in workforce planning and resource utilisation. Deployment of such a tool across the NHS that would mean that the right pharmacists saw the right patients at the right time, to deliver high quality and efficient pharmaceutical care to all patients.

Lay abstract: Almost one in ten prescriptions written in hospital contains an error and pharmacists are vital to detect and resolve them. Currently, pharmacists attempt to see all patients daily, Monday to Friday, but their time is stretched and some patients are not seen. The current NHS cost-cutting means that hospital pharmacies, like all other departments, are under pressure to do &ldquo;more for less&rdquo;. However, not everyone admitted to hospital needs the same level of pharmacist involvement every day. Factors such as how sick they are and how many medicines they are on mean that some people need more intense pharmacy input and some people need less. If managers can assign pharmacy staff with the right level of experience to review the right patients, this might both improve patient safety and save money. Nurses have developed tools that classify the severity of a patient s condition and the intensity of care they will need. These tools ensure that patients are looked after by the right staff with the right skills in the right place. Within pharmacy, there are no equivalent ways of identifying whether a patient needs intense care or if a pharmacist with less experience is required. This work will develop a tool to screen patients for the complexity of their pharmaceutical needs to help target delivery of clinical pharmacy services on admission to hospital. We will first send a survey to NHS hospitals to find out the current systems for assessing such patient need. This will lead on to pharmacy and medical experts participating in multiple on-line surveys to develop the best possible screening tool for evaluating patient complexity. The resulting tool will be tested as to whether it is usable and to understand the best data to collect to evaluate the impact that the tool has on patients and pharmacists.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE