This document describes an analysis of data from an on-call pharmacy service in NHS Tayside, Scotland from April 2015 to March 2016. It found that the service received 839 calls during this period, averaging 70 calls per month or 2.3 calls per shift. The busiest days were Saturdays and Sundays, receiving over 45% of the total calls. Nurses were the primary users of the service, accounting for nearly two-thirds of calls. The most common requests were for supplies of medicines, medication information, and discharge prescriptions. Most calls were resolved within 30 minutes.
The NHS has a chronic access problem, linked to ever increasing demand for healthcare. This means that patients sometimes have to wait a long time for advice and treatment. Long waits run counter to modern consumer expectations and can have adverse clinical consequences. Community pharmacy – a walk in service located close to where people live, work and shop - must surely be part of the solution.
This document provides recommendations to improve new patient wait times for the NeuroMedicine Pain Management Program (NMPMP) at the University of Rochester Medical Center. It analyzes scheduling and billing data from January 2011 to June 2013. The regional market assessment found 40 competing pain clinics, with most having wait times over 14 days, which is the standard set by URMFG. Analysis of NMPMP data showed the current wait time is 30 days, below the desired 80% of new patients seen within 14 days. Adding provider capacity through hiring a nurse practitioner is recommended to reduce wait times while maintaining financial viability.
The future vision of Homecare medicinesHome Care Aid
This document summarizes the key findings and recommendations from a review of homecare medicines in England. It finds issues with the current homecare medicines market such as unstable cash flows, weak governance, and a lack of collaboration between organizations. It recommends strengthening governance within NHS trusts, developing national standards for homecare providers, and more open and collaborative procurement between trusts, commissioners, providers, and patients to improve services and value for money. The goal is to establish safer, more effective and efficient homecare medicine delivery that works in the best interests of both patients and taxpayers.
This document discusses capacity planning for radiation treatment machines at Cancer Care Ontario. It provides background on Cancer Care Ontario's role in managing radiation treatment services and current capacity. Between 2000-2012, the number of linear accelerators (linacs) grew from 65 to 100 across Ontario. The document discusses Cancer Care Ontario's Radiation Treatment Capital Investment Strategy (RTCIS) for determining needs. Forecasting shows demand for cancer treatments increasing to 42% of cases in 2020 and 48% in 2031, requiring additional linacs. The recommendation is to add 16 linacs between 2013-2017 in phases at various cancer centers based on forecasted demand.
1) Clinical pharmacist interventions have been shown to improve outcomes for patients with chronic kidney disease (CKD), reducing hospital admissions, length of stay, and incidence of end-stage renal disease or death.
2) The Manitoba Renal Program (MRP) developed standards of clinical practice for their renal pharmacists to define core activities like attending clinics and rounds, performing medication reconciliation, and reviewing medications.
3) The standards were developed through evaluating literature on renal pharmacists' roles, surveying MRP pharmacists, and involving pharmacy managers and stakeholders. They prioritize activities and ensure consistent patient care across the province.
Hassan Argomandkhah - electronic Transfer of Care to Pharmacy training sessionInnovation Agency
Presentation by Hassan Argomandkhah, Pharmacy LPN Chair (Merseyside), NHS England, at the electronic Transfer of Care to Pharmacy training session on Tuesday 22 January at Formby Hall Golf Resort and Spa
Hassan Argomandkhah - Transfers of Care Around MedicineInnovation Agency
Presentation by Hassan Argomandkhah, Pharmacy LPN Chair (Merseyside), NHS England at the Transfers of Care Around Medicine training session on Thursday, 26 September at The Village Hotel, Wirral.
Baseline Study of Private Drug Shops in Bangladesh-Findings and RecommendationsMd. Tarek Hossain
Retail drug shops are the preferred first point of contact for a majority of the population in developing countries including Bangladesh. Currently in Bangladesh, 1,03,451 licensed retail drug shops and approximately an equal number of unlicensed retail drug shops are involved in selling drugs "over-the-counter". Most of the salespeople and dispensers at those retail drug shops do not have training in dispensing drugs or in offering diagnoses and treatment, which they frequently do.
Because those drug shop salespeople have no other channel of information beyond the formal sectors open to them, they fall easy prey to the aggressive marketing strategies of the pharmaceutical companies. Irrational use of drugs such as over-prescribing, multi-drug prescribing, using unnecessarily expensive drugs, dispensing drugs without a prescription, and overusing antibiotics and injections have been the most common problems found with those retailers for a long time.
Given the importance of the informal sector, including retail drug shops in Bangladesh, improved regulation of this sector offers an important opportunity to improve community health. Experiences in other parts of world have demonstrated that private-sector drug seller initiatives that are based on an accreditation and regulation model are feasible, improve access to medicines, and can be scaled up.
This study aims to fill in the knowledge gaps about those unregulated drug shops in the private sector and about management of them through the informed design of an accredited drug shop model in Bangladesh. The inclusion of the tuberculosis-related assessment in this study is a result of the priority for a TB program that will increase the number of cases that are detected and referred early to a TB treatment and diagnosis center for proper management.
The NHS has a chronic access problem, linked to ever increasing demand for healthcare. This means that patients sometimes have to wait a long time for advice and treatment. Long waits run counter to modern consumer expectations and can have adverse clinical consequences. Community pharmacy – a walk in service located close to where people live, work and shop - must surely be part of the solution.
This document provides recommendations to improve new patient wait times for the NeuroMedicine Pain Management Program (NMPMP) at the University of Rochester Medical Center. It analyzes scheduling and billing data from January 2011 to June 2013. The regional market assessment found 40 competing pain clinics, with most having wait times over 14 days, which is the standard set by URMFG. Analysis of NMPMP data showed the current wait time is 30 days, below the desired 80% of new patients seen within 14 days. Adding provider capacity through hiring a nurse practitioner is recommended to reduce wait times while maintaining financial viability.
The future vision of Homecare medicinesHome Care Aid
This document summarizes the key findings and recommendations from a review of homecare medicines in England. It finds issues with the current homecare medicines market such as unstable cash flows, weak governance, and a lack of collaboration between organizations. It recommends strengthening governance within NHS trusts, developing national standards for homecare providers, and more open and collaborative procurement between trusts, commissioners, providers, and patients to improve services and value for money. The goal is to establish safer, more effective and efficient homecare medicine delivery that works in the best interests of both patients and taxpayers.
This document discusses capacity planning for radiation treatment machines at Cancer Care Ontario. It provides background on Cancer Care Ontario's role in managing radiation treatment services and current capacity. Between 2000-2012, the number of linear accelerators (linacs) grew from 65 to 100 across Ontario. The document discusses Cancer Care Ontario's Radiation Treatment Capital Investment Strategy (RTCIS) for determining needs. Forecasting shows demand for cancer treatments increasing to 42% of cases in 2020 and 48% in 2031, requiring additional linacs. The recommendation is to add 16 linacs between 2013-2017 in phases at various cancer centers based on forecasted demand.
1) Clinical pharmacist interventions have been shown to improve outcomes for patients with chronic kidney disease (CKD), reducing hospital admissions, length of stay, and incidence of end-stage renal disease or death.
2) The Manitoba Renal Program (MRP) developed standards of clinical practice for their renal pharmacists to define core activities like attending clinics and rounds, performing medication reconciliation, and reviewing medications.
3) The standards were developed through evaluating literature on renal pharmacists' roles, surveying MRP pharmacists, and involving pharmacy managers and stakeholders. They prioritize activities and ensure consistent patient care across the province.
Hassan Argomandkhah - electronic Transfer of Care to Pharmacy training sessionInnovation Agency
Presentation by Hassan Argomandkhah, Pharmacy LPN Chair (Merseyside), NHS England, at the electronic Transfer of Care to Pharmacy training session on Tuesday 22 January at Formby Hall Golf Resort and Spa
Hassan Argomandkhah - Transfers of Care Around MedicineInnovation Agency
Presentation by Hassan Argomandkhah, Pharmacy LPN Chair (Merseyside), NHS England at the Transfers of Care Around Medicine training session on Thursday, 26 September at The Village Hotel, Wirral.
Baseline Study of Private Drug Shops in Bangladesh-Findings and RecommendationsMd. Tarek Hossain
Retail drug shops are the preferred first point of contact for a majority of the population in developing countries including Bangladesh. Currently in Bangladesh, 1,03,451 licensed retail drug shops and approximately an equal number of unlicensed retail drug shops are involved in selling drugs "over-the-counter". Most of the salespeople and dispensers at those retail drug shops do not have training in dispensing drugs or in offering diagnoses and treatment, which they frequently do.
Because those drug shop salespeople have no other channel of information beyond the formal sectors open to them, they fall easy prey to the aggressive marketing strategies of the pharmaceutical companies. Irrational use of drugs such as over-prescribing, multi-drug prescribing, using unnecessarily expensive drugs, dispensing drugs without a prescription, and overusing antibiotics and injections have been the most common problems found with those retailers for a long time.
Given the importance of the informal sector, including retail drug shops in Bangladesh, improved regulation of this sector offers an important opportunity to improve community health. Experiences in other parts of world have demonstrated that private-sector drug seller initiatives that are based on an accreditation and regulation model are feasible, improve access to medicines, and can be scaled up.
This study aims to fill in the knowledge gaps about those unregulated drug shops in the private sector and about management of them through the informed design of an accredited drug shop model in Bangladesh. The inclusion of the tuberculosis-related assessment in this study is a result of the priority for a TB program that will increase the number of cases that are detected and referred early to a TB treatment and diagnosis center for proper management.
A study in Vietnam found that using a rapid five-minute test to detect C-reactive protein (CRP) can significantly reduce unnecessary antibiotic use for respiratory infections in both adults and children, while achieving the same clinical recovery rates. This was the first such study conducted in a resource-constrained setting, and it showed similar results to trials conducted in Europe. It was also the first trial to assess CRP tests for children.
Este documento presenta el panorama energético de Chile, analizando problemas como la alta dependencia de las importaciones de energía primaria y el aumento proyectado de la demanda energética. Propone una solución integral involucrando al estado, empresas y personas, con medidas como prohibir ampolletas incandescentes, incentivar vehículos eficientes, mejorar la eficiencia industrial y promover el uso de energías renovables entre la población, como ocurre en California. Concluye que se requiere un acuerdo nacional para orientar el país hacia un mayor ahor
El documento explora varias preguntas sobre el sábado desde una perspectiva bíblica. Explica que aunque Dios no dio un mandato directo para guardar el sábado, Él lo santificó y lo bendijo después de descansar el séptimo día de la creación. Dios entregó el sábado a Adán como un día de descanso para recordar la obra creadora de Dios.
Este documento define la novela como una narración ficticia en prosa que tiene como objetivo causar placer estético en los lectores a través de descripciones de eventos interesantes, personajes, pasiones y costumbres. Explica que la novela puede incluir diversos géneros literarios y tiene muchos subgéneros como novela histórica, de aventuras, policíaca, realista e intimista. También menciona algunos ejemplos notables de cada tipo de novela.
Este documento habla sobre la arquitectura gótica. Explica que se originó en el norte de Francia en el siglo XII y luego se expandió a otras regiones de Europa. Describe los elementos característicos de este estilo como el arco apuntado, la bóveda de crucería, los contrafuertes y arbotantes, y las ventanas de vidriera. También cubre los diferentes subestilos como el gótico francés, inglés y otros. El objetivo es presentar la historia y características distintivas de esta arquitectura
Muhammad Naveed Afzal is a Pakistani telecommunications engineer seeking a job in telecommunications. He has over 7 years of experience in fields like GPON/FTTH installation and maintenance, mobile network planning and implementation, and microwave network troubleshooting. His experience includes roles at Etisalat UAE, ZTE Pakistan, Celeros Networks, Huawei Technologies, and various other telecom companies in Pakistan and the UAE. He has technical skills in areas such as GPON, FTTH, mobile network planning, microwave networks, and optical fiber installation and splicing.
La historia trata sobre una carrera de ranas para subir una torre mientras la multitud las animaba negativamente diciendo que no podrían lograrlo. Todas las ranas fueron desistiendo una a una por los comentarios negativos, excepto una rana sorda que continuó subiendo hasta ganar porque no podía oír los comentarios desalentadores. El mensaje es que no dejemos que los comentarios negativos de otros nos hagan desistir de nuestros sueños y metas.
La Informática Jurídica y el Derecho están interrelacionados y se benefician mutuamente. La Informática Jurídica incluye la documentación jurídica, la gestión de casos legales, y el apoyo a la toma de decisiones jurídicas a través de sistemas expertos. La Teoría General de Sistemas provee un marco para entender los sistemas jurídicos de manera holística e interdisciplinaria.
La autora siempre ha disfrutado de la moda y encontró alivio al dibujar sus propios diseños. Organizó un evento de pasarela con un grupo de amigos que consistió en 4 desfiles, el cual le ayudó a entender mejor el trabajo en equipo y lo que se requiere para completar un proyecto serio.
CCM began producing hockey skates in 1905 using leftover scrap steel from their bicycle and automobile plants. In 1937, CCM acquired the Tackaberry brand and "Tacks" became CCM's signature skate until late 2006. Over 100 years, CCM has been a leader in hockey equipment manufacturing.
Swisscom AG implemented application performance monitoring using Brocade's Analytics Monitoring Platform to gain visibility into application performance across its large, complex storage network supporting many enterprise customers. This identified oversubscribed ports causing high latency, allowing Swisscom to redistribute traffic and reduce peak latency by over 90%. It reduced troubleshooting time from 30 days to under 10 minutes and improved reporting and assurance of SLA compliance for customers.
El documento habla sobre conceptos epistemológicos como conocimiento científico, criterios de justificación del conocimiento, y estrategias para buscar conocimiento. También discute conceptos como técnica, procedimiento, objetivo, habilidades, y problema; y las relaciones entre estos conceptos y disciplinas como sociedad y filosofía.
La revista habla sobre la creatividad y ofrece varios ejercicios y consejos para desarrollarla. Explica qué es la creatividad, cómo saber si uno es creativo, y presenta ejercicios como escribir palabras con condiciones específicas, crear analogías, hacer preguntas, trabajos colaborativos, buscar usos inusuales de objetos y más. También da consejos como estudiar las reglas antes de romperlas, dejar fluir las ideas al relajarse, y prevenir el bloqueo creativo mediante la planificación y los
Pablo anuncia el evangelio de la promesa hecha a los padres de Israel. Explica que Dios escogió a Abraham y sus descendientes, los liberó de Egipto, les dio la tierra prometida, y les dio jueces y reyes como Saúl y David. Prometió enviar a un salvador, Jesús, descendiente de David, para cumplir la promesa. La salvación es por la fe en Jesús y no por las obras de la ley.
Este documento trata sobre estadística médica. Explica conceptos básicos como definición de términos estadísticos, la relación entre la estadística y el método científico, y las aplicaciones de la estadística en medicina como diagnóstico, pronóstico y nuevos tratamientos. También describe las etapas del método científico y cómo la estadística apoya cada etapa, incluyendo la observación, formulación de hipótesis y verificación.
Este documento describe varios dispositivos de entrada comunes para computadoras, incluyendo teclados, mouse, escáneres, cámaras web, micrófonos y lápices ópticos. Explica la evolución y tipos de teclados y mouse, así como cómo funcionan y se usan escáneres, cámaras web y micrófonos.
Este documento presenta un resumen de la obra "El gato negro" de Luis Sepúlveda. Narra la historia de un gato negro que cuida de una gaviota herida y su polluelo, y promete enseñarle a volar a la cría cuando sea mayor. Con la ayuda de sus amigos gatos, intentan investigar cómo cuidar una gaviota y enseñarle a volar, hasta que finalmente logran su objetivo con la ayuda de un humano.
Este documento presenta información sobre la gestión financiera de una empresa llamada T&D S.A. La empresa necesita actualizar su tecnología para aumentar la producción, reducir los costos y cumplir con la demanda de los clientes. El documento explica el problema de la empresa, los objetivos de la actualización tecnológica, y proporciona un marco de referencia sobre conceptos clave de gestión financiera como el análisis costo-beneficio y el apalancamiento.
Este documento describe varios dispositivos de entrada comunes para computadoras, incluyendo teclados, mouse, escáneres, cámaras web, micrófonos y lápices ópticos. Explica la evolución y tipos de teclados y mouse, así como cómo funcionan y se usan escáneres, cámaras web y micrófonos.
Where is Real World Evidence? Finding sources for the outcomes that matterSVMPharma Limited
SVMPharma Real World Evidence (RWE) – In this article we examine the conventional sources of RWD and also evaluate their strengths and weaknesses, and when you may consider utilising each data source for RWE. For more resources on RWE visit us at www.svmpharma.com
The Future NHS Plans: Delivering Transformation and SustainabilityMark Reading
This document discusses improving communication between GPs and hospital consultants through a service called Consultant Connect. It provides concise summaries of key points:
1. Consultant Connect allows GPs to get quick specialist medical advice from hospital consultants through a single dial-in phone number, digitally recording the calls for tracking and reporting.
2. The service has proven popular with over 50,000 calls annually covering 10.9 million patients across 38 NHS areas. On average, calls are answered within 54 seconds and last over 4 minutes.
3. Studies show the service avoids around 20-30% of unnecessary admissions to A&E or hospitals and 67% of unnecessary referrals for elective specialties like cardiology
A study in Vietnam found that using a rapid five-minute test to detect C-reactive protein (CRP) can significantly reduce unnecessary antibiotic use for respiratory infections in both adults and children, while achieving the same clinical recovery rates. This was the first such study conducted in a resource-constrained setting, and it showed similar results to trials conducted in Europe. It was also the first trial to assess CRP tests for children.
Este documento presenta el panorama energético de Chile, analizando problemas como la alta dependencia de las importaciones de energía primaria y el aumento proyectado de la demanda energética. Propone una solución integral involucrando al estado, empresas y personas, con medidas como prohibir ampolletas incandescentes, incentivar vehículos eficientes, mejorar la eficiencia industrial y promover el uso de energías renovables entre la población, como ocurre en California. Concluye que se requiere un acuerdo nacional para orientar el país hacia un mayor ahor
El documento explora varias preguntas sobre el sábado desde una perspectiva bíblica. Explica que aunque Dios no dio un mandato directo para guardar el sábado, Él lo santificó y lo bendijo después de descansar el séptimo día de la creación. Dios entregó el sábado a Adán como un día de descanso para recordar la obra creadora de Dios.
Este documento define la novela como una narración ficticia en prosa que tiene como objetivo causar placer estético en los lectores a través de descripciones de eventos interesantes, personajes, pasiones y costumbres. Explica que la novela puede incluir diversos géneros literarios y tiene muchos subgéneros como novela histórica, de aventuras, policíaca, realista e intimista. También menciona algunos ejemplos notables de cada tipo de novela.
Este documento habla sobre la arquitectura gótica. Explica que se originó en el norte de Francia en el siglo XII y luego se expandió a otras regiones de Europa. Describe los elementos característicos de este estilo como el arco apuntado, la bóveda de crucería, los contrafuertes y arbotantes, y las ventanas de vidriera. También cubre los diferentes subestilos como el gótico francés, inglés y otros. El objetivo es presentar la historia y características distintivas de esta arquitectura
Muhammad Naveed Afzal is a Pakistani telecommunications engineer seeking a job in telecommunications. He has over 7 years of experience in fields like GPON/FTTH installation and maintenance, mobile network planning and implementation, and microwave network troubleshooting. His experience includes roles at Etisalat UAE, ZTE Pakistan, Celeros Networks, Huawei Technologies, and various other telecom companies in Pakistan and the UAE. He has technical skills in areas such as GPON, FTTH, mobile network planning, microwave networks, and optical fiber installation and splicing.
La historia trata sobre una carrera de ranas para subir una torre mientras la multitud las animaba negativamente diciendo que no podrían lograrlo. Todas las ranas fueron desistiendo una a una por los comentarios negativos, excepto una rana sorda que continuó subiendo hasta ganar porque no podía oír los comentarios desalentadores. El mensaje es que no dejemos que los comentarios negativos de otros nos hagan desistir de nuestros sueños y metas.
La Informática Jurídica y el Derecho están interrelacionados y se benefician mutuamente. La Informática Jurídica incluye la documentación jurídica, la gestión de casos legales, y el apoyo a la toma de decisiones jurídicas a través de sistemas expertos. La Teoría General de Sistemas provee un marco para entender los sistemas jurídicos de manera holística e interdisciplinaria.
La autora siempre ha disfrutado de la moda y encontró alivio al dibujar sus propios diseños. Organizó un evento de pasarela con un grupo de amigos que consistió en 4 desfiles, el cual le ayudó a entender mejor el trabajo en equipo y lo que se requiere para completar un proyecto serio.
CCM began producing hockey skates in 1905 using leftover scrap steel from their bicycle and automobile plants. In 1937, CCM acquired the Tackaberry brand and "Tacks" became CCM's signature skate until late 2006. Over 100 years, CCM has been a leader in hockey equipment manufacturing.
Swisscom AG implemented application performance monitoring using Brocade's Analytics Monitoring Platform to gain visibility into application performance across its large, complex storage network supporting many enterprise customers. This identified oversubscribed ports causing high latency, allowing Swisscom to redistribute traffic and reduce peak latency by over 90%. It reduced troubleshooting time from 30 days to under 10 minutes and improved reporting and assurance of SLA compliance for customers.
El documento habla sobre conceptos epistemológicos como conocimiento científico, criterios de justificación del conocimiento, y estrategias para buscar conocimiento. También discute conceptos como técnica, procedimiento, objetivo, habilidades, y problema; y las relaciones entre estos conceptos y disciplinas como sociedad y filosofía.
La revista habla sobre la creatividad y ofrece varios ejercicios y consejos para desarrollarla. Explica qué es la creatividad, cómo saber si uno es creativo, y presenta ejercicios como escribir palabras con condiciones específicas, crear analogías, hacer preguntas, trabajos colaborativos, buscar usos inusuales de objetos y más. También da consejos como estudiar las reglas antes de romperlas, dejar fluir las ideas al relajarse, y prevenir el bloqueo creativo mediante la planificación y los
Pablo anuncia el evangelio de la promesa hecha a los padres de Israel. Explica que Dios escogió a Abraham y sus descendientes, los liberó de Egipto, les dio la tierra prometida, y les dio jueces y reyes como Saúl y David. Prometió enviar a un salvador, Jesús, descendiente de David, para cumplir la promesa. La salvación es por la fe en Jesús y no por las obras de la ley.
Este documento trata sobre estadística médica. Explica conceptos básicos como definición de términos estadísticos, la relación entre la estadística y el método científico, y las aplicaciones de la estadística en medicina como diagnóstico, pronóstico y nuevos tratamientos. También describe las etapas del método científico y cómo la estadística apoya cada etapa, incluyendo la observación, formulación de hipótesis y verificación.
Este documento describe varios dispositivos de entrada comunes para computadoras, incluyendo teclados, mouse, escáneres, cámaras web, micrófonos y lápices ópticos. Explica la evolución y tipos de teclados y mouse, así como cómo funcionan y se usan escáneres, cámaras web y micrófonos.
Este documento presenta un resumen de la obra "El gato negro" de Luis Sepúlveda. Narra la historia de un gato negro que cuida de una gaviota herida y su polluelo, y promete enseñarle a volar a la cría cuando sea mayor. Con la ayuda de sus amigos gatos, intentan investigar cómo cuidar una gaviota y enseñarle a volar, hasta que finalmente logran su objetivo con la ayuda de un humano.
Este documento presenta información sobre la gestión financiera de una empresa llamada T&D S.A. La empresa necesita actualizar su tecnología para aumentar la producción, reducir los costos y cumplir con la demanda de los clientes. El documento explica el problema de la empresa, los objetivos de la actualización tecnológica, y proporciona un marco de referencia sobre conceptos clave de gestión financiera como el análisis costo-beneficio y el apalancamiento.
Este documento describe varios dispositivos de entrada comunes para computadoras, incluyendo teclados, mouse, escáneres, cámaras web, micrófonos y lápices ópticos. Explica la evolución y tipos de teclados y mouse, así como cómo funcionan y se usan escáneres, cámaras web y micrófonos.
Where is Real World Evidence? Finding sources for the outcomes that matterSVMPharma Limited
SVMPharma Real World Evidence (RWE) – In this article we examine the conventional sources of RWD and also evaluate their strengths and weaknesses, and when you may consider utilising each data source for RWE. For more resources on RWE visit us at www.svmpharma.com
The Future NHS Plans: Delivering Transformation and SustainabilityMark Reading
This document discusses improving communication between GPs and hospital consultants through a service called Consultant Connect. It provides concise summaries of key points:
1. Consultant Connect allows GPs to get quick specialist medical advice from hospital consultants through a single dial-in phone number, digitally recording the calls for tracking and reporting.
2. The service has proven popular with over 50,000 calls annually covering 10.9 million patients across 38 NHS areas. On average, calls are answered within 54 seconds and last over 4 minutes.
3. Studies show the service avoids around 20-30% of unnecessary admissions to A&E or hospitals and 67% of unnecessary referrals for elective specialties like cardiology
Rebecca Rosen: Supply-induced demand in primary careNuffield Trust
In this slideshow Dr Rebecca Rosen, Senior Fellow, Nuffield Trust, discusses the concept of supply-induced demand as it relates to primary health care. She discusses the factors driving demand for increased service access and the unclear nature of the relationship between increased access and continuity of care.
Dr Rosen spoke at the event: "Supply induced demand as it relates to general practice" (http://www.nuffieldtrust.org.uk/talks/supply-induced-demand-it-relates-general-practice) in March 2014.
Improving Access to Seven Day Services: one size does not fit all NHS Improving Quality
Presentation given by Dr Rob Haigh, Deputy Medical Director and Chief of Medicine, Western Sussex Hospital NHS Foundation Trust, at the Improving access to seven day services event. Crawley 11 March 2015.
Rachel Dorsey-Campbell, dmd prescribing & monitoringMS Trust
Rachel Dorsey-Campbell describes how the MS service at Hillingdon Hospital was expanded to become a full MS prescribing center. Originally, MS patients from Hillingdon were referred to Imperial College Hospital for treatment with disease-modifying therapies. This caused delays and a disjointed service. By engaging stakeholders from both trusts and obtaining funding transfers from Imperial, Hillingdon was enabled to prescribe and monitor first-line MS drugs locally while continuing complex case discussions through a shared multidisciplinary team meeting. This change improved access and care coordination for MS patients in the local area.
The AHSN and Centre for Implementation Science is working as the independent evaluator for the Happy, Healthy, at Home Vanguard programme in North East Hampshire and Farnham.
This was the second symposium of the independent evaluation and focused on the Farnham Locality. The event included presentations from the Farnham Integrated Care Team and the Farnham Referral Management Service, as well as a series of ‘Evaluation Stations’ where delegates spent time with teams from Farnham, North East Hampshire and Farnham CCG and NHS England.
The event was attended by a wide-range of people who are interested in seeing how the vanguard programme is making changes to the local health system in North East Hampshire and Farnham and who are interested in evaluation approaches. These are the collected slides from the day.
The Never Full Practice project aims to expand urgent care provision at a general practice in Merseyside by increasing clinical and administrative capacity without compromising existing services. An initial review of over 1,000 patient records found that 75-80% of urgent care occurs during current GP hours, and 55% of A&E visits are between 9am-6pm on weekdays. The results suggest 100% of walk-in center contacts and 40% of A&E visits could be managed by the practice. The project aims to establish evidence for changing urgent care provision and assess similar efforts underway elsewhere in England.
The General Practice Forward View - what does it mean for my practice?Robert Varnam Coaching
The document discusses pressures on general practice from increasing population, consultations, complexity and costs while funding and workforce are decreasing relatively. It notes the rise of multimorbidity with age which accounts for over half of primary care work and represents a qualitative change from episodic illness to ongoing management of multiple chronic conditions. The General Practice Forward View aims to address these challenges through actions like expanding the workforce, reducing bureaucracy, implementing online booking and reminders, and establishing multispecialty community providers for more comprehensive community care.
SVMPharma Real World Evidence – Real World Evidence as a driver of HTA approv...SVMPharma Limited
SVMPharma Real World Evidence (RWE) – In this article we examine the benefits of RWE in support of HTA submissions and re-submissions, and ask whether RWE is something you can afford to pass up. For more resources RWE visit us at svmpharma.com
The document discusses the role and functions of a drug information center located within a hospital pharmacy. It describes how drug information centers collect and compile drug information from various sources and make it available to doctors and other medical professionals to answer drug-related queries and inform clinical decision-making. The centers are typically equipped with extensive reference materials, journals, and sometimes electronic databases. Their goal is to provide up-to-date, evidence-based drug information to improve patient care and safety.
- Home-based medication therapy management (MTM) services were integrated into a large urban health system between September 2012 and December 2013. A pharmacist provided 74 home visits to 53 patients.
- Most referrals (66%) came from the internal medicine clinic, with about half from physicians and 23% from pharmacists. The top reasons for referral were nonadherence, transportation barriers, and the need for medication reconciliation with home care nurses.
- On average, patients had 3 medication-related problems identified during the home visits. The most common problem was non-compliance, affecting 40% of patients. Home-based MTM allowed for direct assessment of factors influencing medication use and improved care coordination.
The document outlines a pilot project called "Opening Doors" which aims to provide improved and extended primary care access for patients in Morecambe, UK from 8am to 8pm, 7 days a week. The pilot will cover over 61,000 patients across 4 practices and involve collaboration with out-of-hours, same day minor illness, ambulance, and district nursing services. During the week, practices will have extended hours and on weekends a central site will provide appointments with doctors and receptionists who can access full patient records. The pilot aims to prevent unnecessary hospital attendances and admissions by directing patients to the most appropriate care. Outcomes will be measured to assess patient satisfaction, costs, and impact on emergency department and hospital
Indoor patients’ satisfactory influential factors’ on healthcare services of ...HeenaRaffi1
This document discusses a study on factors influencing indoor patient satisfaction with healthcare services at small and medium-sized multi-specialty hospitals in Tiruchirappalli, India. The study examined patient satisfaction across four dimensions: healthcare services, supportive services, auxiliary services, and peripheral services. Adequate ward arrangements had the highest average patient satisfaction score. Statistical analysis found significant associations between overall patient satisfaction and all measured healthcare service factors. A neural network model with 7 input layers, 20 covariates layers, 1 hidden layer, and 1 output layer accurately modeled patient satisfaction based on socio-demographic and service quality factors.
Rob Duncombe was named the Working with Finance - Clinician of the Year for his work as director of pharmacy at The Christie NHS Foundation Trust. He has implemented two initiatives that have improved patient care while reducing costs. The first, a cyclical prescribing scheme for chemotherapy patients, introduced monthly check-in phone calls with pharmacists instead of 3-month prescriptions, reducing wastage by £50,000 in the first pilot. The second was outsourcing pharmacy dispensing, saving £1 million annually while maintaining services. Duncombe aims to share these initiatives to benefit patients and save costs across Greater Manchester.
AN EMPIRICAL STUDY ON FACTORS INFLUENCING THEPATIENTS SATISFACTION TOWARDS HE...IAEME Publication
This document summarizes a research paper on factors influencing patient satisfaction towards healthcare services at multi-specialty hospitals in Trichy, India. The study aimed to understand patient profiles, factors for hospital selection, and satisfaction levels with primary and supportive services. 748 patients from 5 hospitals were surveyed. The results showed that the majority of respondents were satisfied with primary and supportive healthcare services. Recommendations to hospital administrators and the government included staff training programs, clear billing practices, improved sanitation, physician supervision of medical services, and public health awareness campaigns.
NHS Greater Glasgow & Clyde serves over 1.2 million people across six acute sites and faces challenges of an aging population with complex health conditions requiring multiple medications. Prior to PharmacyView, pharmacists did not have electronic access to patient clinical information or prioritization status at the bedside. PharmacyView enables NHS Greater Glasgow & Clyde pharmacists to view patient prioritization for care, access information across devices and locations, and better allocate resources to high-risk patients, improving continuity of care and productivity. The application has now been rolled out across six major acute hospitals in NHS Greater Glasgow & Clyde.
This review takes a look at some of the NHS England highlights over the last year, and includes real life case studies which show how the NHS put patients first.
Fully established on 1 April 2013, NHS England is an Executive Non-Departmental Public Body responsible for overseeing the running of the NHS. It aims to improve the health of people in England by working in an open, evidence-based and inclusive way, keeping patients at the heart of everything it does.
Healthcare at Home: There's no place like homeConor Henry
Healthcare at Home and the clinical homecare expert panel, have launched their second report “There’s no place like home”. The report shows the NHS in England could save a potential 500,000 bed days each year if every acute trust used virtual wards at the same scale as the trusts studied for the report. This could save at least £120 million, or 21% of all NHS providers’ predicted deficit for 2016-2017.
After publishing their first report last year, 'Building the case for clinical care in the home', the expert panel were challenged to quantify the actual savings that clinical care in the home could make. “There’s no place like home” marks the first time that independently validated data has been able to do this.
The report analysed the records of more than 9,000 patients who had been cared for on a virtual ward between October 2012 and May 2016, comparing them to more than 4.2 million patients who had received all their care in NHS hospitals. Both patients and acute trusts benefited from the virtual ward: the acute trusts saved money and gained capacity. The trusts in the study are estimated to have saved £490 for each inpatient spell that is for each continuous period of time a patient’s medical care was the responsibility of a hospital consultant.
Healthcare at Home is proud to be part of, and support, the clinical homecare expert panel. Its work building the case for, and quantify the saving available by implementing, clinical care in the home will continue beyond this report into next year.
The next step for acute trusts is to explore how to make clinical care in the home work in their area. The methodology we used in this report can be modelled to demonstrate savings for individual trusts.
If you would like to discuss this further or be involved in the next piece of work, please contact hello@hah.co.uk.
1. A pharmacist reviewed pharmacy operations in Broken Hill, NSW and identified issues with patients' medication management during transitions between the local hospital and nursing home. Medication lists were often incomplete or inaccurate.
2. The pharmacist proposed allowing the hospital access to the pharmacies' database of patients' medication histories to address this issue. A secure system was set up, with patient consent, to share medication information for nursing home residents with the hospital pharmacy and emergency department.
3. By providing the hospital access to complete and up-to-date medication lists, the new system aims to improve patient health and safety by reducing medication errors during transitions of care between facilities. Early signs indicate the system has positively impacted medication management
Similar to Eur J Hosp Pharm-2017-Dunn-ejhpharm-2016-001138 (1) (1) (20)
1. On-call hospital pharmacy services: a perspective
from NHS Tayside, Scotland
John Dunn
Pharmacy Department,
Ninewells Hospital, Dundee,
UK
Correspondence to
John Dunn, Pharmacy
Department, Ninewells
Hospital, Dundee, DD1 9SY,
UK; johdunn2@nhs.net
Received 19 October 2016
Revised 13 December 2016
Accepted 14 December 2016
EAHP Statement 4: Clinical
Pharmacy Services
To cite: Dunn J. Eur J Hosp
Pharm Published Online
First: [please include Day
Month Year] doi:10.1136/
ejhpharm-2016-001138
ABSTRACT
Aim To describe the enquiries to an out-of-hours
pharmacy on-call service and to describe the activity of
this service from April 2015 to March 2016.
Method Data entered by on-call pharmacists into the
‘On Call’ app database at a large teaching hospital were
reviewed retrospectively. Data were analysed using
OpenOffice Calc.
Results 839 on-call enquiries were received in the data
collection period, averaging 70 calls per month or 2.3
calls per shift. The busiest days were Saturdays (26.0%
of total calls, 218/839) and Sundays (20.0% of total
calls, 168/839). The vast majority of calls were received
before midnight (91.8%, 770/839), with most of these
being received between 09.00 and 20.00 (68.1%, 571/
839). The number of calls varied greatly between
months with the least calls being received in April (37)
and the most in January (100). Nurses were the main
users of the service with 62.8% (527/839) calls. Junior
doctors were the other main users with 26.2% (220/
839) of calls. Most calls involved queries regarding the
supply of medicines (30.0%, 252/839), Medicines
information requests (26.8%, 225/839) or requests to
dispense discharge prescriptions (17.6%, 148/839). The
majority of calls were resolved within 30 min (82.4%,
691/839) and a significant proportion answered within
10 min (48.6%, 408/839). The average time taken to
resolve a call was 22 min. More experienced members of
the service were able to resolve calls more quickly than
the more junior (averages of 26.64 vs 19.73 min).
Conclusions This article provides a commentary on the
pharmacy on-call service within NHS Tayside and an
in-depth look at what an on-call service entails.
INTRODUCTION
‘On-call’ is a term used frequently within health-
care by many different professions. The implica-
tions vary greatly between groups of staff and
between health boards but at the most basic level,
on-call is defined as being available to work
outwith one’s normal working hours. Hospital
pharmacy departments routinely provide on-call
services. The recent article by Cheeseman and
Rutter1
discussing the provision of on-call hospital
pharmacy service in NHS England provided a valu-
able insight into how on-call services are provided
in NHS England. In addition, a 2013 article by
Heath et al2
provided an insight into on-call ser-
vices in St Vincent’s Hospital in Sydney, Australia.
The current article attempts to describe the on-call
service from a Scottish perspective based on work
undertaken within NHS Tayside, Scotland.
As noted by Cheeseman and Rutter,1
traditional
working hours for hospital pharmacy are between
09:00 and 17:00, Monday to Friday. The experi-
ence in NHS Tayside coincides with this as pharma-
cists are available between the hours of 08:00 and
18:00, but with the core hours remaining as
09:00–17:00. At weekends, there are minimal clin-
ical pharmacy services although the dispensary is
open 10:00–13:30. This set-up leaves periods of
time during the week and at weekends where
there are no pharmacists on site. These times are
collectively known as out of hours (OOH).
Pharmaceutical service provision during the OOH
period is provided by the pharmacy on-call service.
In NHS Tayside, the pharmacy on-call service pro-
vides OOH support to all acute, mental health and
community hospitals within the managed service of
NHS Tayside. In exceptional cases, there may also
be requests from the General Practitioner (GP)
OOH services, community pharmacy, private hos-
pitals or the police/prison service after other
options have been pursued. Given the wide range
of areas, which could potentially require support,
the pharmacy on-call service within Tayside has
agreed to the following criteria for calls3
:
▸ Initiation of class 1 drug alert.
▸ Chemical, biological, radioactive, nuclear attack;
major incident procedure.
▸ Breach in pharmacy department security (in
conjunction with key holders) or cold store
alarm.
▸ Supply of critically urgent medicines, unavail-
able from wards/departments in Tayside (includ-
ing National Holding Centre medicines).
▸ Provision of medicines information, for queries
unable to be answered from use of available
sources on NHS Tayside pharmacy website and
senior medical and nursing staff.
As will be discussed subsequently, these five cat-
egories can be further subdivided into more specific
call types.
In NHS Tayside, the structure of the on-call
service changed significantly after the national
review of on-call systems took place across the
UK.4
In 2012, the Scottish government published
guidance based on recommendations from this
review, which changed the way in which on-call
pharmacists were remunerated and the way in
which on-call services were provided.5
One of the
key recommendations was that the working week
should be split into a maximum of nine on-call
sessions:
▸ Monday to Friday—one session each day (each
session should be no more than 16 hours).
▸ Saturday and Sunday—two sessions each day
(each session should be no more than 12 hours).
▸ Public holiday—two sessions each day (each
session should be no more than 12 hours).5
Dunn J. Eur J Hosp Pharm 2017;0:1–7. doi:10.1136/ejhpharm-2016-001138 1
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2. This represented a significant change from the previous struc-
ture and triggered a review of the service as a whole within
NHS Tayside. Following this review, the NHS Tayside pharmacy
on-call service now has:
▸ A rota that is populated by pharmacists working in several
hospitals and settings across Tayside (secondary care pharma-
cists and pharmacists based in GP practice), that is, a
Tayside-wide rota.
▸ A system for ensuring compensatory rest in line with Section
27 of the Agenda for Change NHS Terms and Conditions of
Service Handbook.6
▸ On-call shifts allocated on a sessional basis as described
above.
In addition to this change in structure, robust training, induc-
tion, mentorship and peer review systems have also been put in
place. Within the last 2 years, the NHS Tayside pharmacy
on-call service has also implemented a completely paperless call
recording and reporting system, using the ‘On Call Pharmacy’
app. This has been developed in conjunction with NHS Tayside
by the software development company Softaware and has
afforded the NHS Tayside pharmacy on-call service many bene-
fits. One such benefit is the ability to generate a database of calls
that can be interrogated easily. This article has been made pos-
sible by the use of data extracted from the ‘On Call Pharmacy’
app. Prior to the implementation of the app, none of the data
presented in this article was able to be collected or analysed. In
recognition of all the work done and the changes made, the
NHS Tayside pharmacy on-call team were nominated and short-
listed as finalists for the Team of the Year Award at the Scottish
Pharmacy Awards in 2015.7
METHOD
Data entered into the ‘On Call’ app database by on-call pharma-
cists throughout NHS Tayside were collected retrospectively for
the period of April 2015–March 2016. The data were analysed
using OpenOffice Calc. The analysis looked at sorting the data
using the following fields: overall number of calls, number of
calls per hour, day and month, enquirer, category of call and the
time calls took to answer.
RESULTS
The results presented are for the time period of April 2015–
March 2016 (financial year 2015–2016) inclusive unless other-
wise stated.
Activity of the service
The NHS Tayside pharmacy on-call service received 839 calls
(70, or 9.3% resulting in pharmacist attendance to the hospital)
in the OOH period from April 2015 to March 2016. This
equates to 70 calls per month, 16 calls per week or 2.3 calls per
on-call shift on average. There is very little published literature
describing how many calls pharmacy on-call services receive.
Cheeseman and Rutter1
suggests that most on-call services in
NHS England receive up to 20 calls per week relating to supply
of medicines (65.3%) and up to 20 calls per week relating to
medicines advice (83.6%). However, Heath et al reported that
their on-call service received 963 calls over a 10-year period.
The activity of the NHS Tayside on-call service is more in line
with the experiences in NHS England, although received calls
maybe categorised in different ways in different services thus
not allowing direct comparison. Until this point, it has been
thought that pharmacy on-call services are busier at the week-
ends than during the week. Figure 1 demonstrates this is the
case in Tayside and shows how many calls were received each
day of the week.
Nearly half of all calls (46.0%, 386/839) were received over
the weekend with Saturday being the busiest day with 26.0%
(218/839) of all calls. There is very little difference in number of
calls received during the week with around 10% (9.7–11.7) of
calls received each weekday. There are potentially a number of
factors why weekend shifts receive more calls. Pharmacy opening
hours at weekends is likely to play a significant role. The on-call
service starts once the dispensary closes. In NHS Tayside, the dis-
pensary closes and thus the on-call service begins at 13.30 on
Saturdays and Sundays compared with 17.00 during the week.
Thus, on-call shifts on Saturdays and Sundays are 3.5 hours
(22%) longer than shifts during the week. In addition, there are
very few pharmacists on the wards over the weekends in com-
parison to weekdays meaning queries that are usually dealt with
by the ward pharmacist are more likely to be asked to the on-call
pharmacist. Looking in more detail at when calls are received,
figure 2 shows which hours of an on-call shift are the busiest.
Figure 2 shows that no calls (0.0%, 0/839) were received
between the hours of 10:00 and 13:00. This is expected as the
dispensary is always open during these hours and therefore
there is no on-call service. Between the hours of 13:00 and
17:00, 29.1% (244/839) of calls were received. These calls are
attributable to weekend on-call shifts as there is no pharmacy
on-call service during these hours on weekdays. Figure 1 shows
that 46.0% of calls are received at weekends and figure 2
demonstrates that 29.1% of calls are between 13:00 and 17:00
(weekend calls). It can therefore be deduced that 16.9% of
weekend calls fall within the hours of 17:00–10:00. In other
words, 63% (29.1/46) of calls at the weekend occur during
what would be considered normal pharmacy working hours
during the week. Figure 2 also demonstrates that a significant
number of calls are received between the hours of 17:00 and
20:00 (38.3%, 321/839). This is the most common time for the
on-call service to be contacted. Possible reasons for this are that
clinical pharmacy services stop at 17:00 in most cases and the
dispensary closes at 18:00. However, there is still significant
activity in clinical areas after these times. Therefore, there is
often pharmaceutical advice required beyond core pharmacy
working hours. In addition, most wards have a drug round at
around 18:00 meaning nurses are likely to identify issues with
medicine administration at this time. Also, it is common for
patients to be transferred from admission wards to other wards
in the evening. This process can also lead to medication issues
and present the need to contact the on-call pharmacy team.
Overall, figures 1 and 2 combined show that over two thirds of
calls (68.1%, 571/839) are received between the hours of 09:00
and 20:00 throughout the week. In comparison, only 8.2% (69/
839) are received between 00:00 and 10:00. This is very similar
to the results reported by Heath et al2
where 7% of their calls
were received between 00:00 and 08:00.
The final measure relating to the activity of the service is how
much variation occurs throughout the year. Figure 3 shows how
many calls were received each month throughout the last finan-
cial year.
It can be seen from figure 3 that there is significant variation
in the number of calls received throughout the year as the
busiest month (100 calls) being almost three times as busy as the
quietest month (37 calls). There are many factors that could
contribute to this variation. One factor is the rotation of junior
doctors. In the UK, new doctors start in August each year. New
doctors then rotate every 4 months to different areas. There is
some correlation between these rotations and the number of
2 Dunn J. Eur J Hosp Pharm 2017;0:1–7. doi:10.1136/ejhpharm-2016-001138
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3. calls displayed in figure 3. August sees a peak in calls, which
then gradually reduces over the course of the next 4 months. A
similar trend is seen from December to March. April to July is
less in keeping with this pattern, perhaps because the junior
doctors have gained more experience by this stage.
Users of the service
There is very little detail in the literature regarding who contacts
pharmacy on-call services. Anecdotally, it is thought nursing
staff are the main users. Administration of medicines is a key
nursing role and therefore nurses are likely to need advice about
medicines. It is expected that junior doctors would also be
major users of the services since they provide a significant pre-
scribing role. Figure 4 shows the breakdown of who calls the
pharmacy on-call service within Tayside.
Figure 4 demonstrates that the majority of calls come from
nurses (62.8%, 527/839). Junior doctors (all grades below con-
sultant) made up the majority of the other callers (26.2%, 220/
839). The remainder of calls came from a wide variety of other
healthcare professionals and members of staff within and
outwith the secondary care setting.
Types of calls
As described above, the NHS Tayside pharmacy on-call service
receives calls from a wide variety of callers. This variety of
callers results in a variety of types of calls. Previous studies have
described on-call queries as belonging to one of two broad cat-
egories: supply of medicines or medicines information.1 2
Although most queries could be classified in this way for NHS
Tayside, calls have been broken down into more detailed cat-
egories, as shown in figure 5.
Calls that are classified as medicines supply or medicines
information accounted for 56.9% (477/839) of calls.
Prescription requests made up 17.6% (148/839) of calls. A pre-
scription request was defined as a person calling to ask if a dis-
charge prescription could be dispensed outwith normal
pharmacy hours or if the on-call pharmacist knew of the loca-
tion of a discharge prescription. The remaining 25.5% (214/
Figure 1 Which days did the on-call team receive their calls?
Figure 2 At what time did the on-call team receive their calls?
Dunn J. Eur J Hosp Pharm 2017;0:1–7. doi:10.1136/ejhpharm-2016-001138 3
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4. 839) of calls fell under other categories such as advice on Total
Parenteral Nutrition (TPN), advice on transferring or borrowing
medicines from other departments or hospitals, calls regarding
the security of the department or fridge temperature breaches
(alarm call outs) or chemotherapy.
How long do calls take to answer?
The NHS Tayside on call pharmacy service defines a call as start-
ing when the on-call pharmacist answers the initial phone call.
The call is complete once the query has been resolved. In cir-
cumstances when it is necessary to attend the hospital to resolve
the query, the call will end once the on-call pharmacist has
returned home. Some enquiries are more complex than others
and therefore require more time to address. Very little literature
is published describing how long calls take to answer. On
average, on-call queries were answered in 22 min. Figure 6 dis-
plays the length of calls within NHS Tayside.
Most calls were dealt within 30 min or less (82.4%, 691/
839), with almost half of calls (48.7%, 409/839) being resolved
within 10 min. There was also a significant proportion of calls
(17.6%, 148/839) that required more than 30 min to resolve.
Some of these longer calls can be explained by the requirement
to attend the hospital. However, as described earlier, only 8.4%
(70/839) of calls required attendance to the hospital. Therefore,
almost 1 in 10 (9.3%, 78/839) calls took over 30 min and did
not require attendance to the hospital indicating that they were
likely complex calls.
Cheeseman and Rutter1
discovered that in NHS England, all
grades of pharmacists are involved in providing on-call services,
from band 6 to band 9. This is not the case within NHS Tayside
where junior pharmacists (bands 6 and 7) and a very small
number of senior pharmacists (band 8a) provide the service.
Figure 7 shows the difference in average call length between the
different pharmacist bands.
As expected more experienced pharmacists took less time to
deal with calls. On average, calls took 35% longer (26.6 min
compared with 19.7 min) to be answered by band 6 pharmacists
than band 8a pharmacists. One of the perceived benefits of
Figure 3 Number of calls received each month.
Figure 4 Which staff groups call the pharmacy on-call service.
4 Dunn J. Eur J Hosp Pharm 2017;0:1–7. doi:10.1136/ejhpharm-2016-001138
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5. on-call services being provided by junior pharmacists is that cost
savings may be achieved. Payment for calls is based on hourly
rate of each pharmacist and junior pharmacists have lower
hourly rates. However, figure 7 shows that some of the potential
cost-savings could be offset by more junior pharmacists taking
longer to deal with queries.
DISCUSSION
The results presented in this article provide an account of the
pharmacy on-call service within NHS Tayside. This is the first
article to describe the activity of an on-call service in such
detail. Extensive literature searches revealed that there is very
little data published about on-call pharmacy services.
Nonetheless, there are some aspects for discussion moving
forward.
Extended working hours
At the current time, there is significant pressure for the NHS to
provide more services over a 7-day working week. This has
been brought into the public eye in recent months with the
Figure 5 What categories of calls were received and how many?
Figure 6 How long do queries take to resolve?
Dunn J. Eur J Hosp Pharm 2017;0:1–7. doi:10.1136/ejhpharm-2016-001138 5
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6. proposals for a new junior doctors contract. If this is to be the
direction of travel, it would be expected that more pharmaceut-
ical input would be required over an extended period of time in
comparison to what is currently delivered. It is not clear at
present exactly how this will be delivered or how this will affect
on-call services. If the activity of other services (non-pharmacy)
was to increase, this may cause an increase in the demand for
the pharmacy on-call service. However, if pharmacy services
also expand and pharmacy working hours change to a 7-day
week then the on-call period will be shorter, thus the activity of
pharmacy on-call services may be reduced. The results from
NHS Tayside indicate that most calls are received either at the
weekend or before 20:00 during the week, which would imply
that if extended opening hours were implemented across a
7-day working week, a significant number of calls to the phar-
macy on-call service would be prevented. This would be wel-
comed among on-call pharmacists but may precipitate another
review of the on-call service in due course. For example, in the
Central Manchester University Hospitals Foundation Trust, a
similar extension in hours resulted in the traditional on-call
pharmacist service being replaced by a ‘night-shift’ pharmacist.8
Reduction of inappropriate calls
The types of calls received by the NHS Tayside pharmacy on-call
team is an area that is under constant review. The five criteria that
are deemed appropriate circumstances in which to contact the
pharmacy are mentioned previously. However, some calls do not
fall into any of these categories and in particular are neither urgent
nor emergencies. To address this, the on-call team in NHS Tayside
has introduced a number of measures. Information about how to
source medicines OOH or which information sources to refer to
in order to resolve medicines information queries were made avail-
able on the local intranet pages. In addition, a file, which lists all
medicines stocked in ward areas, and on which wards, was also
made available for staff to use OOH. This allows ward staff to
identify the location of medicines within Tayside and organise the
transfer of the medicine without needing to refer to the on-call
pharmacist. However, there are still a number of calls to the
on-call team that could be resolved without the input of an on-call
pharmacist. The next step to address this issue within Tayside is for
calls destined for the on-call pharmacist to be screened by a
member of the Hospital at Night team. As described previously, a
significant proportion of calls are enquiries about prescriptions
(148/839, 17.6%) or medicine information requests (225/839,
26.8%). It is anticipated that Hospital at Night practitioners will
be able to resolve the majority of these calls thus reducing the
number of calls coming through to the on-call pharmacy team. In
addition, some other centres in the UK have automated dispensing
systems, which can be operated remotely. This allows medicines to
be supplied to wards from pharmacy without pharmacists needing
to attend the hospital. Although such a system is not in place cur-
rently in NHS Tayside, it is something that could be considered in
the future. A combination of these measures could significantly
reduce the time pharmacists spend on straight-forward calls
received, saving money and allowing more time to be dedicated to
more complex queries, which require pharmacist-specific
expertise.
Quality assurance of calls
The data presented in this article have described the calls received
by the NHS Tayside pharmacy on-call service. However, what is
not presented is the response or answers to queries received. The
aim of the service is to provide high-quality advice on a consistent
basis irrespective of which individual pharmacist is on-call.
Induction training and mentoring systems are in place to help
achieve this. However, to ensure calls are answered appropriately,
every call is reviewed by the head of service (or deputy) on a
monthly basis. In addition, frequent peer review meetings are held
in which calls are discussed among the team allowing a consistent
approach to be adopted by the entire team. Any member of the
team can initiate discussion about a call or how a call should be
responded to. Minutes of these meetings are disseminated to the
entire team. In future, feedback from service users will be collected
to determine if the advice given is appropriate and helpful to the
caller. This will also help ensure advice given is consistent between
on-call pharmacists and of a high quality.
CONCLUSION
Pharmacy on-call services are provided by all health boards
during the OOH period. Service set-up and service provision
Figure 7 Average time taken to answer on-call enquiries.
6 Dunn J. Eur J Hosp Pharm 2017;0:1–7. doi:10.1136/ejhpharm-2016-001138
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7. may vary between trusts although many of the themes and chal-
lenges faced are common to all. This article provides a commen-
tary on the pharmacy on-call service within NHS Tayside and an
in-depth look at what an on-call service can provide.
What this paper adds?
What is already known on this subject?
▸ Pharmacy on-call services are provided throughout the UK
and the world by hospital pharmacy departments.
▸ Most calls involve medicines information or medicine supply
type queries.
▸ Very little research has been published describing pharmacy
on-call services in any detail.
What this study adds?
▸ A detailed description of a pharmacy on-call service from
NHS Tayside.
▸ A demonstration of how the use of technology can provide
useful insights into a service.
▸ A reference point for other pharmacy on-call services.
Acknowledgements I would like to thank Helen and Andy Schofield of
Softaware.uk.com for enabling me to use the data generated from the ‘On Call’ app
and Duncan Wilson for playing a major role in implementing the app in NHS
Tayside. I would also like to thank everyone involved with the NHS Tayside pharmacy
on-call service.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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8. perspective from NHS Tayside, Scotland
On-call hospital pharmacy services: a
John Dunn
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