Pharmacy Service Level Agreement to Mental Health Units

XXXXX mental health site 1999/2000

XXXXXXXXX Psychiatric Trust

CLINICAL SERVICE

ACUTE DIRECTORATE

SERVICE TO: MH1 - ADULT ACUTE PSYCHIATRY – (six wards)

SERVICES PROVIDED:

A clinical pharmacist visits each ward daily to monitor all prescriptions. The objective of this visit is to ensure that prescriptions are clear, that prescribing follows local policies/formulary guidance, that prescribing anomalies are clarified and that possible interactions and adverse reactions are checked. We also ensure that blood level monitoring is performed for those drugs requiring this service.

The pharmacist checks ward records to ensure that administration is reconciled against stock supplied. Following this visit, non-stock items, including TTAs and weekend leave medicines are dispensed.

Ward stock is provided by technician top-up on a weekly basis against individualised stock lists.

Clinical pharmacists attend ward rounds on all six admission wards twice a month. The clinical pharmacist has a high profile on these wards and provides essential input into prescribing decisions and drug information to members of the multidisciplinary team.

OUTCOMES: Safe, effective and economic use of drugs. An efficient, comprehensive and timely supply service.

SERVICE TO: MH2 - ADULT PSYCHIATRY – Rehabilitation Services: XXX Ward

SERVICES PROVIDED:

A clinical pharmacist visits Xxxxxx ward every week to monitor all prescriptions. The objective of this visit is to ensure that prescriptions are clear, that prescribing follows local policies/formulary guidance, that prescribing anomalies are clarified and that possible interactions and adverse reactions are checked. We also ensure that blood level monitoring is performed for those drugs requiring this service.

The pharmacist checks ward records to ensure that administration is reconciled against stock supplied. Following this visit, non-stock items, including TTAs and weekend leave medicines are dispensed.

Ward stock is provided by technician top-up on a weekly basis against an individualised stock list.

The clinical pharmacists attends ward rounds twice a month providing essential input into prescribing decisions, and drug information to members of the multidisciplinary team.

OUTCOMES: Safe and economic use of drugs by the Psychiatric Community Service.

SERVICE TO: MH3 ACUTE ADULT PSYCHIATRY – OUT PATIENTS: 5 MHRCs and CPNs; FP10 (HP) prescriptions.

SERVICES PROVIDED: MHRCs and CPNs

The pharmacy distribution service supplies stocks of depot and oral medication for use in the Resource Centres and by the CPN service (CPRT).

Each Centre is visited by a pharmacy technician at least twice a year to ensure that stock is properly rotated, to identify out-of-date items and to prevent overstocking

FP10 (HP) prescriptions - These prescriptions are stamped by the pharmacy staff, picked up by MHRC staff for clinic use and dispensed by Community Pharmacies. There is no direct pharmacy control over these and the PPA recharges the Unit. Forms returned by the PPA are reviewed by the Principal Pharmacist to assess compliance with local policies, prescribing quantity, use of generic names, and reduce fraud etc and to advise on cost control.

All out-patient clozapine dispensing is co-ordinated through the pharmacy department as clozapine can not currently be prescribed by GPs. It is delivered to collection points by arrangement with specialist nurses.

OUTCOMES Efficient and effective pharmacy service to patients in the community

SERVICE TO: MH4 – COMMUNITY ADULT PSYCHIATRY – Rehabilitation Services: The Xxxxxx Hostel

SERVICES PROVIDED:

The XXXX Hostel

A clinical pharmacist visits the Hostel once a week to review all prescriptions and ensure safe storage and adequate supply of medication. The objective of this visit is to ensure that prescriptions are clear, that prescribing follows local policies/formulary guidance, that prescribing anomalies are clarified and that possible interactions and adverse reactions are checked. We also ensure that blood level monitoring is performed for those drugs requiring this service.

Stock and individual medication is supplied by the pharmacy on a same, or next-day-delivery basis

OUTCOMES Efficient and effective provision of medication to patients in the The Limes

EMI DIRECTORATE

SERVICE TO: MH5- ELDERLY MENTALLY ILL(EMI) - IN PATIENTS - 3 WARDS

SERVICES PROVIDED

The service to this unit is essentially as described under Adult Psychiatry except that ward pharmacy visits are provided twice weekly. There is close liaison with the consultants and at their request we attend 2 ward rounds twice a month for each.

OUTCOMES: Safe, effective and economic use of drugs. An efficient, comprehensive and timely supply service. Information and advice provision.

SERVICE TO: MH6 - EMI DAY CENTRE (3 CENTRES)

SERVICES PROVIDED:

Stock is supplied against individual lists. Individual dispensing is provided as required and includes the same-day dispensing of all TTAs for Xxxxxxx Day Hospital. Where appropriate, medication is dispensed into compliance aids.

Centres are visited by a Clinical Pharmacist who liaises with clinicians and Centre managers to develop relevant procedures and advise on the safe storage and handling of medicines. Each centre is visited by a Pharmacy technician at least twice a year, as for MHRCs.

OUTCOMES: Timely supply of agreed stock items and individual dispensing. See management of stock.

SERVICE TO: MH7 - Xxxxxx Court Continuing Care Beds

SERVICES PROVIDED:

Prescribing is carried out using FP10(HP) pads, stamped and issued by the pharmacy department but dispensed by Community Pharmacies. All prescriptions are reviewed by the Principal Pharmacist when they are returned by the PPA.

Supplementary feeds are ordered and supplied directly from pharmacy stores, which has significantly reduced prescribing costs.

OUTCOMES

Enabling an appropriate and cost-effective supply of medication to an off-site facility.

FORENSIC DIVISION

SERVICE TO: MH9 – Local Secure Directorate - 3 PICU (Xxxxx, Yyyyyy and Zzzzzz), Hhhhhhhh I, II and III, Gggggg, Nnnnnn

SERVICES PROVIDED

A dispensary and clinical ward pharmacy service is provided to the directorate. The (named) House wards are visited by a senior Clinical Pharmacist (with Breakaway Techniques training) once a week to monitor prescriptions and discuss treatment with clinical staff. The Xxxxxxx ward consultant rounds are attended frequently, to ensure that all patients are seen at least once a month.

The 3 PICUs are visited by a clinical pharmacist daily, and all consultants’ ward rounds attended twice a month.

It is proposed to provide a technician stock top-up service to these wards as soon as staffing is available. The visiting pharmacist checks stock on the wards not visited by a Technician for expiry dates etc. Each ward orders their own stock

A monitoring and dispensing service is provided for the many patients receiving clozapine, including those discharged into the community

SERVICE TO: MH10 – Regional Secure Directorate – (Xxxxxxxxx + ICU, plus 7 other wards)

SERVICES PROVIDED:

A dispensary and clinical ward pharmacy service is provided to the directorate. All wards are visited by a senior Clinical Pharmacist (with Breakaway Techniques training), once a week to monitor prescriptions and discuss treatment with clinical staff.

The Regional Secure Directorate has an extensive self-medication programme, which involves dispensing individual patients’ medication on a daily/3 daily/weekly basis. In addition, a monitoring and dispensing service is provided for the many patients receiving clozapine.

The RSU receives a full senior technician top-up service. The visiting pharmacist checks stock on the wards not visited by a Technician for expiry dates etc. These wards order their own stock

Changes since last contract:

Xxxxxxxx ward opened.

N new consultants in all units

Future developments:

PHARMACY DEPARTMENT PROCUREMENT, SUPPLY and OTHER SERVICES

SERVICE

I. PURCHASING

Ealing Hospital Pharmacy purchases the following commodities:

Purchasing negotiations take place at different levels including regional (NWT Region Drugs Contract), inter-hospital (West London Purchasing Consortium) and locally, for bulk and special deals.

The prices of many of the items used in the Community and Mental Health Units are the lowest in the country. Purchasing is supported by Quality Control Service which assures the quality of products purchased. At Xxxxxxx Hospital, purchasing is fully computerised and the district drugs store ensures security, proper stock rotation and timely distribution.

OUTCOMES

High quality products supplied at the most competitive prices.

2. DISPENSING SERVICES

A dispensing service is provided for all in-patient, discharge and some out-patient prescriptions seven days a week. Opening hours are Monday to Friday 08.30 to 18.00 and weekends 11.00 to 13.30. A designated pharmacy porter makes regular collections from and deliveries to all wards on site, ensuring that prescriptions are consistently returned as soon as possible.

We ensure a prompt supply of medication in the most appropriate form and container, under the comprehensive supervision of a pharmacist.

Patient counselling is provided where appropriate using the specially designed in-house leaflets produced to cover the groups of medication commonly used in Mental Health units.

A dispensing service for urgent items is available out-of-hours via the on-call service.

OUTCOMES

Timely provision of medicines for individual patients in appropriate storage containers with clear directions on how they should be taken.

SERVICE

3. ON CALL SERVICES

A pharmacist is available at all times to answer medicine - related queries and to supply urgently needed items. When necessary specialist psychiatric advice can also be obtained via the on-call service, contacted by the hospital switchboard.

OUTCOMES

A prompt, reliable and efficient out-of-hours service for advice and supply.

4. MEDICAL GASES PURCHASING AND QUALITY CONTROL

Xxxxxx Hospital purchases medical gases for all units and provides transport for cylinders between units.

Refill costs are paid centrally and recharged on a regular basis. Rental charges are paid on an annual facility basis for all Trusts which reduces costs.

The Regional Pharmaceutical Service provides QC services for pipeline maintenance and gas testing.

OUTCOMES

Prompt supply of medical gases with Quality Assurance support.

5. DRUG INFORMATION (DI) SERVICES

We provide an extensive DI service from a well-resourced centre, with expert and specialist staff.

The drug information service is available to all clinical and management staff and to community pharmacists and GPs. The centre acts as a resource for pharmacists working in the Mental Health unit.

The centre answers all queries concerning prescribing choice, administration, handling and outcomes of drug treatment. Information support is provided for the preparation of policies and procedures relating to medicine usage, the Formulary and Drug and Therapeutics Committee.

OUTCOMES

Prompt, high quality information independently evaluated.

6. PRESCRIBING CONTROL

XXXX Trust has established its own joint Drugs & Therapeutics Committee (DTC), whose remit is to advise practitioners and management groups on the safe, effective and economic use of drugs within the Trust. The Principal Pharmacist participates in the work of this Committee and provides secretarial support.

This multi-disciplinary Committee provides a monitoring mechanism for the introduction of new (and often very expensive) drugs and advice to the Medical Staffing Committee on the implementation of a wide range of medicines related policies. The DTC has agreed that XXXX Trust should have its own Formulary and Prescribing Guidelines for Mental Health. This is to be developed forthwith.

The Xxxxxxx Formulary lists products recommended by local experts in each area of prescribing, and provides a compendium of local guidelines designed to ensure the safe, efficient and economic use of drugs. All drugs have been reviewed and approved by the local DTC.

OUTCOMES

Safe, effective and economic use of drugs.

7. EXPENDITURE REPORTING AND INTERPRETATION TO CLINICAL DIRECTORS

We provide regular reports and analysis of expenditure on medication, and advice on cost containment measures when appropriate, for all clinical departments, consultants and financial management groups.

This service ensures that budget holders are kept informed of expenditure.

The information is essential at budget planning when we look at cumulative drugs expenditure (reported down to individual consultant or clinic) against factors including impact of new drugs, clinical trials in hand, changes in product patent life, patient activity etc in developing likely budget requirements for the new year.

OUTCOMES

Quality usage analysis to ensure effective use of financial allocation.`

8. PROVISION OF EMERGENCY TREATMENT PACKS

Emergency treatment packs are prepared and distributed for use in emergency situations. A register is maintained detailing all issues to ensure regular replacement of infrequently used packs prior to their expiry date.

OUTCOMES

In-date medications available for emergencies in packs appropriate for emergency situations.

9. TRAINING

We provide lectures and seminars on all aspects of the handling, administration and use of medicines, with reference to the Trust Medicines Policy where appropriate.

These sessions are designed to ensure that the handling and use of medicines is carried out in an informed way, thus promoting efficiency and safety in medicine usage.

Our clients for this include all grade of nursing staff , junior doctors, multidisciplinary groups, parents and carers.

OUTCOMES

Safe handling, storage and use of medicines.

10. QUALITY CONTROL

We provide a QC service for monitoring products, environment and service.

A 24-hour recall service is in operation to ensure that drugs that are unsafe are withdrawn from use as soon as notice is received.

OUTCOMES

Quality assurance of the products and services provided by the Pharmacy.

11. AUDIT AND RESEARCH

The team of pharmacists is regularly actively involved in the collection and collation of information for multidisciplinary audit and research. The pharmacy department is also undertaking an audit of users of the service provided. The Principal Pharmacist is a member of the Trust Research and Development Committee to contribute on medication-related issues.

OUTCOMES

Ongoing prescribing evaluation and best-practice research to continually optimise cost-effective drug use.

12. MANAGEMENT OF CLINICAL TRIALS

Xxxxx Pharmacy provides clinical trial support through trial design and supervision, Ethical Committee participation, dispensing and maintenance of essential records.

Our aim is to ensure that clinical trials are properly constructed, unbiased and ethical. The dispensing service assures supply of these materials in suitable presentations.

OUTCOMES

Safe management of clinical trials.

PHARMACY DEPARTMENT – Clinical Management Services

TRUST INDUCTION PROGRAMME

The Senior Pharmacist attends all induction programmes to introduce the pharmacy service to all new Trust employees. The Principal Pharmacist has a scheduled place in the Junior Doctor’s induction to convey information on prescribing policies and local practice with respect to medication.

OUTCOMES

Integration in Trust staff programmes

POLICIES AND PROCEDURES GROUP

The Principal Pharmacist is a member of this Trust Committee, advising on medication related issues and assisting in the compilation and revision of policies e.g. Medicine Policy, Illicit Substances Policy

OUTCOMES

Standard setting and assurance of good practice with respect to medication issues.

RISK MANAGEMENT, RISK ASSESSMENT and CNST

The Principal Pharmacist is a member of these Trust Committees, participating in the training programme and carrying out assessments in relation to the safe storage and use of medication.

Patient Information Leaflets (PILs) were produced by the pharmacy to meet the requirement for CNST Level 1 accreditation. These are now being updated to accommodate the joint Trust opinions, and other leaflets will be added to the series.

OUTCOMES

Identification and reduction of risk to individuals and the Trust with respect to medication

13. CONTROLS ASSURANCE - Medicine Management

The pharmacy department is reporting on the requirements of this initiative and producing an action plan as required for each of the other areas for assessment.

OUTCOMES

Report to the Trust on the current status and future development of medicine management

Clinical Governance

DETAIL

Pharmacists record their activities in the form of Intervention Reports. These refer to the type of activity carried out with respect to a particular prescription concern, the relative risk of the concern and the final outcome of the action taken. A summary of these will be tabled for consideration by the Clinical Governance group quarterly

OUTCOMES

Fulfilment of NHS requirement for clinical governance of medication issues

March 2000