The pharmacy department at Whittington Health implemented a seven day clinical pharmacy service to support patient safety and early discharge. Previously, pharmacy services were only available Monday through Saturday with no Sunday service. The new service expanded pharmacy hours to seven days a week and created new staff positions. This allowed pharmacists to review medications for weekend admissions and discharges, providing prescriptions support for doctors and medication reconciliation. The expanded service facilitated 1700 safe weekend discharges per year and early medication optimization for weekend admissions.

1. Implementation of a seven day clinical pharmacy service within Whittington Health to support
patient safety and early discharge in October 2012
Sarah Davis, Poureya Aghakhani and Helen Taylor
Whittington Health Pharmacy Department
Before
Monday to Friday 09:00 –
17:30
Saturday 09:00 – 11:30
Sunday NO SERVICE
Steps taken
Results
Pharmacy hours extended to cover the weekend.
Providing targeted clinical services.
Six new posts created. (2x Band 7 pharmacists, 4xBand 4
technicians. Cost offset by reduction in length of stay)
Staff weekday working hours adjusted to ensure weekend
teams can be resourced.
Each pharmacy staff member covers one Saturday or Sunday
every six weeks.
Facilitates safe and early discharges
Before:
No weekend
discharges
unless organised
during the week
After:
Increased capacity for safe and early discharge.
1700 patients discharged on weekends per year with
full medication optimisation and review by a
pharmacist
(Based on figures 01/08/2013 – 29/10//2013)
Prescribing support for junior doctors made available
Very limited weekend pharmacy support to an acute
hospital serving 440,000 people
Before:
On-call
pharmacist
support only
Challenges requiring change:
Medicines reconciliation
• Address national weekend mortality data.
Dr Foster (The UK leading health information company) 10th edition
Goddard et al; Higher senior staffing levels at weekend and reduced mortality;
BMJ2012;344:e67
Before:
No medicine
reconciliation
within 24 hours
for weekend
admissions
7 days a week 09:00 – 17:30
• Meet local acute commissioning standards so that
all patients admitted at weekends receive a clinical
pharmacy review of their medication.
Weekend team structure
Team leader overseeing both Clinical and
dispensing teams (09:00 – 17:30)
National Institute for Health and Care Excellence (2007) Technical patient safety
solutions for medicines reconciliation on admission of adults to hospital.
PSG001. London: National Institute for Health and Care Excellence
• Support earlier discharges over the weekend to
reduce length of stay.
After:
Junior doctors have access to the pharmacists
medicines expertise on wards in high risk areas.
Pharmaceutical care can be optimised much earlier
for the 100+ patients admitted over each weekend.
Band 8a+
Pharmacist
(team leader)
Band 7
Pharmacist
Covering:
•Acute
admissions
Band 6
Pharmacist
Covering:
•Acute surgery
Clinical
Technician
Supports clinical
pharmacists
Clinical team
09:00 – 17:30
Team design working well
Covering:
•Intensive care
•Paediatrics
•Neonatology
Dispensary
Pharmacist
After:
Pharmacy reconcile and optimise medications for
new medical and surgical admissions within the
NICE standard of 24 hours, for the majority of
patients admitted each weekend day.
• Screens and
checks
prescriptions
Dispensing Technician
Pre-registration pharmacist,
student technician or assistant
technical officer
Dispensing team
10:00 – 14:00
Positive feedback
about the service
change from
doctors nurses,
and patients.