This ED tweet chat will be a conversation around your pharmacy service within ED and how medicines use is optimised in this setting.  Join us at 8pm, Thursday 21st March to discuss the impact that pharmacy teams can have in the emergency department, share your good practice and identify learning and next steps

GIRFT Emergency Medicine

The overarching objective of the GIRFT Medicines Optimisation cross cutting theme is to contribute an element of medicines optimisation to all clinical workstreams. One of our priority workstreams is Emergency Medicine and the team are working very closely with the GIRFT team.  Early findings and themes can be found at https://gettingitrightfirsttime.co.uk/medical-specialties/emergency-medicine/. 

As part of the workstream, we are keen to showcase your good practice especially around innovations in the utilisation of the pharmacy workforce in the emergency department (ED) and how you have optimised the use of medicines in this area.  We intend to use your good practice to inform case studies in the National Report.

In particular, we are looking at the 3 outputs below and examples of medicines/ pharmacy areas within these outputs are outlined below.

1.  Workforce

• The Pharmacists in Emergency Departments (PIED-Eng)¹ study considered the potential for pharmacist independent prescribers trained in clinical health assessment skills to be deployed in Emergency Departments (EDs). 

2.  Work and Patient flow

• The NHSI Rapid Improvement guide on Optimising Medicines Discharge (https://improvement.nhs.uk/resources/rapid-improvement-guide-optimising-medicines-discharge/) states that pharmacy dispensing at the point of discharge should be the exception. 
• Across England there are now over 4,000 community pharmacies registered to provide urgent prescription items that have recently been prescribed on an NHS prescription (via any NHS service) as part of the NHS Urgent Medicines Supply Advanced Service (NUMSAS). 
• A recent study internally validated a prognostic model, the Medicines Optimisation Assessment Tool (MOAT), aimed at targeting hospital patients most in need of pharmacists’ input based on their risk of moderate or severe preventable medicine related problems². 

3.  Clinical

• The pharmacy team at Chesterfield Royal Hospital undertakes regular falls reviews on patients whom are elderly with polypharmacy having presented with a fall. If the team are unable to make medication changes in the emergency department then they take the opportunity to write to the patients GP with medication recommendations to help prevent future falls.
• A study in an academic teaching hospital in shows that a clinical emergency medicine pharmacist has multiple roles in the early management of patients presenting with sepsis, severe sepsis, or septic shock in the ED. Most commonly, they have a role in optimizing empiric antibiotic selection and dosing; thereby ensuring adequate antimicrobial coverage in this complex patient population³.

About GIRFT 

The Getting It Right First Time (GIRFT) is a national programme designed to improve the quality of care within the NHS by reducing unwarranted variations. By tackling variations in the way services are delivered across the NHS, and by sharing best practice between trusts, GIRFT identifies changes that will help improve care and patient outcomes, as well as delivering efficiencies such as the reduction of unnecessary procedures and cost savings. 

Importantly, GIRFT is led by front line clinicians who are expert in the areas they are reviewing. This means the data that underpins the GIRFT methodology is being reviewed by people who understand those disciplines and manage those services daily. The GIRFT team visit every trust carrying out the specialties they are reviewing, investigating the data with their peers and discussing the individual challenges they face. The programme began with orthopaedics and is now being rolled out to over 35 different surgical and medical specialities across the NHS.

References

1. Health Education England. Pharmacists in Emergency Departments - A Commissioned study by Health Education England. November 2015.

2. Geeson, C, et al.  Development and performance evaluation of the Medicines Optimisation Assessment Tool (MOAT): a prognostic model to target hospital pharmacists’ input to prevent medication-related problems.

3. Weant, KA & Baker, SN. Emergency Medicine Pharmacists and Sepsis Management. Journal of Pharmacy Practice. December 2012.