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EAHP Statement 4: Clinical Pharmacy Services.
Introduction
Medication management within a hospital environment is a complex process usually involving at least four stages from (1) prescribing, (2) transcription and verification, (3) dispensing by nurse to the patient and (4) administration by nurse to the patient.1 Medication management is associated with a risk of errors and inefficiencies across all stages of the process. There is considerable variability in the estimates of medication errors reported in the prescription (approximately 10%–39%), dispensing (approximately 11%–40%) and administration (approximately 10.5%–38%) stages of medication management across different territories with multifactorial causes.2–10 Healthcare policy is therefore focused on methods to reduce the burden of medication errors.1 In recent years, the automation of medication process services such as ordering, dispensing, delivery and administration of medications has been promoted as an important strategy for improving dispensary efficiency, maximising storage capacity and minimising dispensing errors.11 For example, The UK National Health Service has undertaken a review of operational productivity and performance in acute hospitals in England and has recommended a Hospital Pharmacy Transformation Programme (HPTP). A key part of this HPTP is to develop services by “increasing pharmacist prescribers, e-prescribing and administration, accurate cost coding of medicines and consolidating stockholding by April 2020, so that pharmacists and clinical pharmacy technicians spend more time on patient-facing medicines optimisation activities”. There are initiatives and guidelines to improve medication safety and automation is one of the proposed important strategies.12–16
There are many commercially available systems developed to automate in-hospital pharmacy services and the most advanced systems allow for integration of multiple technologies (such as barcode scanning for dispensing and electronic medical record systems) to increase patient safety and the efficiency of healthcare professionals, and to improve pharmacy inventory functions.11 In the pharmacy, these systems can improve organisation of drugs, monitoring of expiration dates and preparation of prescriptions. Automatic stock control and replacement ordering improves efficiency, requiring less technician time. This latter issue is important, as up to 55% of pharmacy staff time is reported to be spent on ‘infrastructure services’, the largest component of which is supply chain activities which includes the buying, making and supplying of medicines. Finally, there is a reduced risk of medication errors.11 These automated systems...