Evaluating the impact of clinical screening by a hospital pharmacy team on the homecare prescription service
Authors: Rawlinson C , Hardaker E , Philpot A 
Published: November 2022

Abstract

Introduction
The homecare prescription service delivers medicines initiated by hospital prescribers directly to patients. The Trust utilises homecare services for approximately 4,000 patients spanning a range of specialities. Historically, homecare prescriptions were directly sent to the homecare company by clinicians and hospital pharmacy received payment invoices. In response to published professional standards for homecare1, the hospital pharmacy clinical screening process was introduced to ensure the safe use of medicines and to reduce wastage.

Aim
To evaluate the impact on pharmacy clinical screening on the homecare prescription service by: Identifying query types and measuring the error rate; and, measuring query resolution times and the delay in prescription processing.

Methods
The data collection was conducted over a 6-month period commencing November 2021 at a teaching NHS Trust. The sample included 100% of homecare prescriptions received by the hospital pharmacy department. Pharmacy technicians involved in the processing of payment invoices recorded the number of received prescriptions. During the clinical screening process, pharmacists involved in the identification of queries or errors relating to homecare prescription documented the presenting issue, any action taken, and the outcome on a purposefully created data collection form. The data was entered into Excel and analysed descriptively. This service evaluation did not require ethical approval.

Results
In total, 4,580 homecare prescriptions were clinically screened by the pharmacy team. Most prescriptions had no issues; 2.5% (n=114) had a query raised. Of these queries, 47% (n=54) necessitated clarification from prescribers without subsequent prescription amendments; 14% (n=16) required new blood tests; 13% (n=15) required prescription amendments; 8% (n=9) resulted in prescriptions being returned and not reissued; and 18% (n=20) had no documented outcome. A lack of recent in-range blood test results accounted for 39% (n=45) of queries. Data were collected during the Covid-19 pandemic, potentially impacting on patients’ ability to obtain blood tests every 3-6 months, depending on indication, to comply with Trust policy.2 Dosage enquiries accounted for 26% (n=30) of queries; most arose from discrepancies between the prescription and the most recent clinic letter. The prescribing error rate was low: 1% (n=40) of prescriptions had an error identified during the evaluation. Time from clinical screening to resolution of the raised issue was documented on 82% of (n=93) forms. Of these queries, 50% (n=46) were resolved within 3 working days, 45% (n=42) took up to 14 days, and 5% (n=5) over 14 days.

Discussion/Conclusion
The introduction of hospital pharmacy clinical screening of homecare prescriptions reduced prescription errors and increased safety of the service by ensuring patients had required monitoring and appropriate medicine doses. However, the project identified that clinical screening added additional processing time for those prescriptions with discrepancies, therefore potentially leading to delays in patients receiving their medications. Further work is planned to improve clarity of clinical letters and create a more robust process in achieving timely query resolutions. The main strength of the project was the relatively large sample size and prolonged data collection period. Limitations included accuracy of the recorded data on the enquiry forms for data analysis.

References
1. Royal Pharmaceutical Society (RPS). Professional Standards for Homecare Services in England. [internet] Royal Pharmaceutical Society; 2013 [cited 2022 May 20]. Available from: https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Professional%20standards%20for%20Homecare%20services/homecare-standards-final-sept-13.pdf
2. Hull University Teaching Hospitals NHS Trust. SOP 16.2-Management of low and medium tech homecare paper prescriptions. Hull; Hull University Teaching Hospitals NHS Trust; 2022 [cited 2022 May 20].