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 Pharmacy Clinical Pharmacy Quality Assurance Formulary & Medicines Management Procurement Dispensing & Distribution

Clinical Pharmacists – Back Office Functions Clinical Governance & Risk Management Guidelines, Policies, & Protocols Evaluation & Audit Research & Research Support Financial Governance & Risk Management Expenditure Reports & Analysis Commissioning QIPP Education & Development (Multiprofessional) Under- & Post- Graduate Teaching Competence Assessment & Peer Review eLearning Management & Leadership Strategic Vision & Direction HR, Employee Relations, & Recruitment Project Management Medicines Management Formulary Safe & Secure Handling 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 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 are safe and effective Patients are satisfied with information about their medicines Patients receive the correct medicines in a timely manner Medicines Reconciliation Medication Review Safe Discharge Timely Supply Provision of Patient Information 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 Guidelines, Policies, & Protocols Evaluation & Audit Research & Research Support Clinical Governance & Risk Management Guidelines, Policies, & Protocols Evaluation & Audit Research & Research Support Financial Governance & Risk Management Commissioning QIPP Financial Governance & Risk Management Commissioning QIPP Education & Development (Multiprofessional) Under- & Post- Graduate Teaching Competence Assessment & Peer Review eLearning Education & Development (Multiprofessional) Under- & Post- Graduate Teaching Competence Assessment & Peer Review eLearning Management & Leadership Strategic Vision & Direction Project Management Management & Leadership Strategic Vision & Direction Project Management Medicines Management Formulary Medicines Management Formulary Expenditure Reports & Analysis HR, Employee Relations, & Recruitment Safe & Secure Handling Quality Assurance

VTE CQUIN Actions VTE Risk Assessment & Appropriate Action Medicines are accurately transcribed on admission and discharge Medicines are accurately transcribed on admission and discharge Medicines are safe and effective Medicines are safe and effective Patients are satisfied with information about their medicines Patients are satisfied with information about their medicines Patients receive the correct medicine in a timely manner Patients receive the correct medicine in a timely manner Medicines Reconciliation Medication Review Safe Discharge Timely Supply Provision of Patient Information Medicines Reconciliation Medication Review Safe Discharge Timely Supply Provision of Patient Information

Pharmacy – CQUIN implementation in 2011-12 VTE Risk Assessment - Evidence-based guidance covering all clinical specialities & Appropriate Action - 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 Thrombosis Committees

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 CLINICAL ADVISORY GROUP (~25 people) Dr Anita Thomas OBE (Chair) CLINICAL ADVISORY GROUP (~25 people) Dr Anita Thomas OBE (Chair) VTE BOARD (~15 people) Dr Anita Thomas OBE (Chair) NCD for VTE DH INTERNAL STAKEHOLDER GROUP Tim Brown VTE PREVENTION TEAM Margaret Candeland (0.3 WTE) Workstreams Professional Leadership AoMRC Patient Awareness & Experience Beverly Hunt Sally Brearley Measurement & Evaluation Anita Thomas Tim Brown Information & Audit Anita Thomas Tim Brown Communications Michael Carden Janine Ford External Reference Groups VTE THREE PROFESSIONS GROUP Rotating Chair: AoMRC; RCN; RPS VTE THREE PROFESSIONS GROUP Rotating Chair: AoMRC; RCN; RPS PREVENTION AND PH [QIPP / CQUIN] 14

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