About our service
Our Pharmacy and Medicines Management team provides a range of services to both acute and community wards and departments including:
- Medicines reconciliation service
- Ward top-up service, dispensing and distribution of medication
- Aseptic chemotherapy service
- Antimicrobial stewardship
- Education and training for medical and nursing staff
- Analysis of medication incidents drug information.
- Lead on safe medication practice, safe and secure handling of medicines and provide controlled drug assurance to the Trust
You can find out more about our services below.
Clinical services
Our Clinical Pharmacy teams support patients to get the most out of their medicines, working as part of an effective multidisciplinary team. We promote best use of medicines, minimise side effects and improve patient safety. Right Medicine, Right Patient, Right Time
Our Clinical Pharmacy service operates on the majority of wards across the Trust. Our specialist and dedicated clinical pharmacy ward teams consist of trained clinical pharmacists, many of whom are prescribers, and pharmacy technicians. We provide services that include:
Ensuring medicines are right when a patient transfers from one care setting to another - most commonly this is from home to hospital. To support this process, we ask patients to bring their own medicines into hospital with them. In addition, the teams have access to the patient's Summary Care Record to obtain further information from Primary Care of the patient's current medication. This enables us to get a more accurate picture of what medicines are being taken.
A holistic review of a patients' medication. This includes supporting patients' understanding of their medicines through counselling and use of patient information resources, ensuring the medication or the device a patient uses to administer medication is appropriate to their individual needs, assessing and addressing barriers to medicines adherence (compliance), and making a specialist contribution to the multi-disciplinary team by providing essential medicines expertise to optimise patient care (this includes being an integral part of consultant-led ward rounds).
Specialist pharmacists are also involved in treatment decision-making and, as independent prescribers, can prescribe appropriate medication.
Towards the end of a patients stay, we will help plan and prepare for transfer home or to another care setting. This will involve effective communication with the multi-disciplinary ward team, the patients GP and community pharmacy. Our teams also offer education, training, advice, and promote the safe and effective use of medicines for the medical and nursing staff on the ward.
Dispensary services
Our Pharmacy department currently dispenses an average of 100,000 labelled prescription items per year from our departments on our two main sites. The average time for a discharge prescription to be completed within Pharmacy is approximately 60 minutes, with over 90% of all discharge prescriptions completed within 2 hours.
The department has a dispensary at Darlington Memorial Hospital and the University Hospital of North Durham. Our dispensaries are committed to provide a high quality and timely service. Staffed by trained and motivated teams, consisting of pharmacy technicians and assistants and supervised by a pharmacist, we aim to ensure our patients receive the right medication, at the right time in the right place.
All discharge prescriptions are professionally checked for accuracy by our pharmacists before they are dispensed. Our teams dispense and check medication for the patients admitted to and discharged from all areas across the Trust.
In outpatient clinics, our prescribers refer medication changes back to the patient's GP for safety reasons or prescribe using standard FP10 prescriptions for clinical urgent and specialist medications. As such patients can take out-patient prescriptions to any community pharmacy (including their usual community pharmacy) to be dispensed.
Clinical trials
A clinical trial is a particular type of clinical research that compares one treatment with another. It may involve patients, healthy volunteers or both. Pharmacy has a vital role to play in relation to clinical research. The pharmacy team safeguard participants, healthcare professionals and the Trust by ensuring trial medications are appropriate for use and are obtained, handled, stored and used safely and correctly.
Our Clinical Trials Pharmacy service ensures that medications used in clinical trials are managed and dispensed in accordance to the study protocol and that clinical trial procedures comply with relevant local and national guidelines and regulations.
Pharmacy staff work closely with our Research and Development department to help to promote research within the Trust. Our work ranges from small scale observational studies to large scale multinational clinical trials within a wide range of conditions. Visit our Research and Innovation page for more information.
Procurement and distribution
Our Pharmacy Procurement and Distribution team are responsible for the procurement, ordering, receipt, storage and distribution of over 5,000 drug lines to over 200 different clinical locations throughout the trust. This team provides an essential component of the pharmacy service without which the other services could not operate.
The team is responsible for the procurement and invoicing of all medicines including specials and unlicensed medicines. Many products are on national or regional contracts but the price paid may also be negotiated at local level.
The department has over 5000 stock lines located in the stores and dispensary areas and the correct receipt and storage of these products is the responsibility of dedicated pharmacy staff. Many products require temperature specific storage and are monitored both manually and electronically.
Our Pharmacy department has a central distribution centre based at UHND that, with the help of an automated dispensing system (the robot), provides a service to all wards and departments across the Trust. Different levels of supply service are provided to the wards and departments ranging from supplying orders generated by the ward to the management of the ward stock including re-stocking of drug locations. The team are responsible for the assembly of ward and clinic orders and their timely delivery to the wards and departments plays an important part in patient care. The team are also responsible for the recycling of medicines and to manage the waste management policy for the department.
Our procurement team also manage the Homecare service where medication is supplied to patients at home by a separate company; this includes the charging of medicines to individual patients.
We have an extensive Antimicrobial Stewardship Program (ASP) with close working relationships between Pharmacists, Microbiologists, the Infection Control Team, Consultants and Senior Managers/Executives. The Antimicrobial Pharmacy team has supported the implementation and development of the ASP since 2008 and during this time the team and their roles have expanded significantly. The Trust has a significant track record in reducing hospital acquired infections since the introduction of the ASP and the Pharmacy staff have played a key role in this.
As antibiotic resistance continues to be a major threat to health, the Trust's Antimicrobial Stewardship Programme (ASP) aims to tackle this by:
- Optimise antimicrobial therapy
- Limit inappropriate antimicrobial use
- Optimise selection, dose, route and duration
- Reduce unintended consequences
- Support the reduction of rates of C difficile and MRSA
To support the aims of the ASP, the departmental team of pharmacists and technicians have developed an extensive antibiotic formulary, which is reviewed regularly with support from consultants, nurses and pharmacists. This Formulary is available via the Trust intranet and will soon be available as a Smartphone App to further improve ease of access. Pharmacists support the ASP with regular ward visits, attendance on the consultant microbiologist ward round and an extensive audit program. These audits are carried out on each of the Trust sites and review the choice and duration of an antibiotic and whether this in accordance with the Antibiotic Formulary. Results are regularly fed back to senior nurses, consultants and prescribers as well as to the Executive Board for discussion.
The pharmacy team also continually monitor our overall usage of antimicrobials and highlight any changes in use, which may warrant investigation/action. As a team we aim to work closely with primary care colleagues to further reduce healthcare associated infections.
Education and Training is a major part of the ASP and we support and deliver teaching sessions to many different healthcare professionals. The department also aims to share this work and the ASP has been presented at numerous national and international conferences.
Most recently we have been extensively involved in the establishment of an Outpatient Parenteral Antibiotic Therapy (OPAT) service, which facilitates the delivery of intravenous (into the vein) antibiotics to patients who are medically stable, within their own home. This eliminates the need to admit patients whose only reason to stay in hospital is to receive IV antibiotic therapy.
Education, training and development
Training is key to developing a skilled workforce and the pharmacy department places a significant emphasis on the training and education of all grade of staff and fully supports the concept of multi-professional learning.
Ensuring patient safety and optimal medicines use requires a knowledgeable and highly skilled workforce. We are totally committed to education and training providing many opportunities for all grades of staff. As part of our role in ensuring the best use of medicines throughout the Trust we also provide teaching and training to other health care professionals particularly as part of the junior doctor programme.
We provide a number of pre-registration placements across the Trust. The pre-registration programme ensures exposure to all aspects of the pharmacy service and is supported by a comprehensive programme of tutorials, case based discussions and small group teaching. See below for more information on:
• Becoming a pre-registration pharmacist at CDDFT
• The programme timetable
• Clinical training sessions
Our junior pharmacist training programme is based on the Competency Development & Education Group's general level framework (GLF) to support and develop our pharmacists through the early years of their career. All of our junior pharmacists complete a post- graduate clinical diploma as part of this training programme. In addition to time to attend university study days our junior pharmacists are supported by attending facilitated study afternoons to discuss clinical scenarios and learn from colleagues. Accompanied ward visits and ward based assessments ensure that by the end of the diploma our junior pharmacists have a portfolio of evidence demonstrating that they meet GLF standards and that they have the competencies to move to the next stage of their career.
All of our senior pharmacists complete the independent prescribing qualification. The continued development of our middle grade and senior staff is ensured through personal development plans. Our staff are supported to attend workshops, conferences and undertake research. Other qualifications may be undertaken depending on personal goals, such as qualifications in management or clinical teaching.
All of our assistants undertake an NVQ level 2 with further training and vocational opportunities for example NVQ level 3 in business and administration identified through personal plans.
The department supports a number of student technicians per year as part of the North East training scheme. Successful candidates are supported through a 2 year vocational course combining on-the-job training with day release to attend Tyne Metropolitan College. We are proud of the extended roles carried out by our technicians and our students gain experience of all of our ward based activities in addition to the more traditional dispensing and preparatory services. The training culminates in the dual award of NVQ level 3 Diploma in Pharmacy Service Skills and the BTEC level 3 diploma in Pharmaceutical Science. The application process for the regional pre-registration pharmacy technician 2 year training programme is advertised in the local press and appears on the NHS jobs site in February or March each year.
All of our technicians undertake training to provide extended roles such as accredited checking and medicines reconciliation services. Further opportunities to develop are actively supported.
In addition to the formal training outlined above, the training ethos of the department is underpinned by an annual programme of seminars and workshops to which everyone contributes and attends. The department has, and continues to develop, strong links with Sunderland University and Durham University Schools of Pharmacy.
For more information, please contact Christine McCartney, Lead Pharmacist (Education and Training)
Performance and governance
Clinical governance is the way the NHS works to improve the quality of care patients receive and to maintain that high quality of care. Clinical governance is the responsibility of every member of NHS staff to ensure that patients receive the best possible care. The Pharmacy Performance, Quality and Safety (PQS) Team support this wider governance agenda by reviewing governance issues related to pharmacy and medicines management.
The Pharmacy Performance Quality & Safety (PQS) team oversee all medicines related governance issues supporting front line clinical teams and corporate governance departments. The team has a specific responsibility for:
A prescribed medicine is the most frequent treatment provided for patients in the Trust; inevitably there are potential risks associated with the use of these medicines.
There are a wide range of factors which influence how patients can access medicines. These factors range from legal frameworks and standards, through to preferences of prescribers and patients. The PQS team support the wider healthcare team to identify and minimise potential areas of risk associated with the use of medicines and facilitate the development of appropriate policies and protocols by the wider healthcare team to support the safe prescribing, supply and administration of medicines by Trust staff.
Within CDDFT there are over 200 acute and community sites, wards and clinics that hold or use medicines. The PQS team support the wider healthcare team to ensure these medicines are stored safely and securely.
Every day, about two and a half million medicines are prescribed in the community and in hospitals across the UK. Most medicines are used safely and help people to get better or stay well. However sometimes there can be a breakdown in the processes associated with the prescribing, dispensing, preparing, administering or monitoring of a medicine; these instances rarely lead to any harm to the patient but there is still important learning to be gained. The PQS team review all medication incident reports and identify areas to support learning across the wider healthcare team.
Business and information
The Business and Information team have a wealth of experience gained through working in Acute and Primary Care settings. They bring together secretarial, admin, IT and data analysis/information functions for the Pharmacy team and provide support with:
- Report on drug usage and prescribing to the trust
- Manage the clinical systems and databases utilised by the pharmacy team
- Support the monitoring and control of departmental budgets
- Co-ordinate pharmacy staff recruitment and manage HR functions
For more information, please contact:
- Deborah Potts, Business Lead Technician
- Elena Matthews or Helen Simpson, Pharmacy Support Officers (BAH)
- Anne Lee, Pharmacy Secretary (DMH)
- Julie Salkeld, Pharmacy Secretary (UHND)
Electronic Prescribing and Medicines Administration (ePMA)
The health secretary announced in January 2013 that the NHS needed to become paperless by 2018; a key element in achieving this target is e-prescribing. In May 2013, the NHS England Safer Hospitals Safer Wards Technology Fund was set up with a budget of£260 million to support trusts in this approach. County Durham and Darlington NHS Foundation Trust has been successful in securing some of this funding to take forward its plans to move away from paper based drug charts and allow the administering of medicines to be done electronically.
At present, the current system for prescribing and administration of medicines in the Trust is based on a model set up over 40 years ago, since then medications used have grown in number and complexity with a resulting potential for greater risk to patients.
To address this, the Trust would like to enhance the prescribing functionality in its existing clinical management systems to enable it to deliver a complete electronic prescribing and medicines management (ePMA) service to its inpatient and day case patients, this will provide a safe and efficient way of prescribing medicines. A project team has been established to ensure the project is delivered on time and within budget.
The associated benefits for patients and clinicians are:
- Increased quality of patient care and services.
- Reduction in the risk of medical errors.
- Decision support will enable clinicians to make more informed, safer decisions so that patients receive the most effective treatments in a more timely fashion.
- Faster processing of discharge prescriptions, meaning patients are able to leave promptly when discharged.
- Accurate up to date information available to clinicians in real time.
The project is in the early stages of implementation and will be rolled out across the Trust following a successful pilot phase. It will take 24 months to substantially roll out the functionality, with the full project completing within 36 months.
The total cost of delivering the project will be £3m. The Trust will receive £823,000 of funding from the Safer Hospitals, Safer Wards Technology Fund to assist us with the delivery of the ePMA project.
For more information, please contact Helen Irving, ePMA Project Manager by email: helen.