Introducing a one-stop dispensing scheme at a mental health unit

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   Introducing a one-stop dispensing scheme
                                            at a mental health unit
                                                                           By D. SMART

One-stop dispensing can reduce both
         drug wastage and the potential for
          error. This article sets out how the
          dispensary manager, a pharmacy
                       technician, co-ordinated the
            introduction of the practice at the
            mental health unit at Clacton and
                                                 District Hospital                        Drug wastage can be reduced by introducing one-stop dispensing schemes

              ne-stop dispensing, the use of            their medicines by the drug trolley, while               about the potential of the scheme and
              patients’ own drugs and self-             the nurses retrieved the drug items from the             encouraged the formation of a steering
              administration of medicines               trolley and administered them.There was no               group, comprising the dispensary manager, a
              were implemented for acute                confidentiality or dignity associated with               charge nurse from the acute mental health
elderly care patients at Clacton and District           this practice. Also, space within the trolley            ward and a member of the clinical audit staff.
Hospital in 1997. Having these practices up             was not adequate for the quantity of medi-               The refined proposal was then presented by
and running for patients in the acute trust             cines stored within it, increasing the risk of           the dispensary manager to both the manage-
highlighted a number of problems with the               administration errors.                                   ment executive committee of the trust and
medicines administration practices at the                  Mental health patients are often encour-              the consultant responsible for the unit, and
mental illness unit in the hospital. For exam-          aged to take short periods of leave before               approval was granted.
ple, at the unit, many patients brought their           their final discharge, as part of their rehabili-           The next step was to identify a suitable
own drugs with them the first time they were            tation assessment. The medicines for these               storage area on the ward and source and pur-
admitted but, because the medicines were                leave periods are often required at short                chase patient-specific medicine containers.
not used, did not bring them in with them               notice, frequently outside normal pharmacy               Briefing sessions were then held with the
again if admitted for a second or subsequent            opening hours, requiring a call to the on-               nursing staff to gain their support for partici-
time.This created risk management problems              call pharmacist for a supply to be made.                 pation in the scheme. Competency-based
from two perspectives. First, admitting doc-            Even during “normal” hours, patients would               training and assessment was carried out
tors often relied on patients’ own drugs as an          need to wait their turn at the busy dispen-              jointly by the charge nurse and the dispen-
important tool in obtaining a drug history on           sary among the routine outpatients.                      sary manager, covering both the issuing and
admission. Not having patients bringing in                 It was therefore decided that a one-stop              checking the medicines for patients to take
their own drugs therefore made drug history             dispensing scheme, using patients’ own drugs             out on leave. Once training was complete,
taking less reliable. Second, if medicines were         could alleviate some of these problems, and              the ward trolley was removed and replaced
changed during a patient’s stay, there was a            create the potential for a future move to                by the medicines containers, stored in a cen-
risk that the patient would be confused when            patients self-administering their own medi-              tral locked cupboard.
they returned home about whether to con-                cines. The most appropriate person to                       The scheme involves the pharmacy dis-
tinue taking their previous drugs in addition           oversee the implementation was the dispen-               pensing a fully labelled 28-day supply of
to those of any new regimen.                            sary manager, a pharmacy technician.                     medicines for each client, together with a
   A review of medicines administration                                                                          duplicate empty container, which is labelled
practices on the acute mental health unit                      DEVELOPING THE SCHEME                             as for discharge. For medicines commonly
also highlighted a number of other issues of                                                                     used,“admission” packs are held on the ward.
concern. At “medicine round” times, the
patients were accustomed to queuing for                 A   draft proposal based on the scheme suc-
                                                            cessfully implemented throughout the
                                                        acute trust, was drawn up by the dispensary
                                                                                                                 These have standard labelling, with spaces for
                                                                                                                 the patient’s details. When these packs are
                                                                                                                 used, the pack and prescription are sent to
                                                        manager, endorsed by the senior pharmacy                 the pharmacy at the next opportunity for
 Ms Smart is dispensary services manager at Essex
                                                        managers and then taken to the mental                    clinical screening and the supply of the
 Rivers Healthcare NHS Trust. She was formerly
 dispensary manager at Clacton and District Hospital
                                                        health unit managers. The manager of the                 empty duplicate pack. The purpose of the
                                                        acute mental health unit was enthusiastic                duplicate packs is to enable registered

J A N U A RY 2 0 0 4   •   VO L . 1 1                               H O S P I TA L P H A R M AC I S T                                                     •   23
nursing staff (who have undergone the rele-              IMPACT OF THE SCHEME                        tion leave from hospital with properly
vant training and assessment) to issue                                                               labelled and packaged medicines.
appropriate small quantities of medicines to
patients for periods of short leave against a
“to take out” prescription written by a doc-
                                                  A     fter some initial nervousness on the part
                                                        of the nursing staff, the scheme is now
                                                  well established at the mental health unit at
                                                                                                           FUTURE PLANS
tor. The issue of medicines is checked by a
second trained registered nurse, before medi-
cines are handed to the patient. It was agreed
                                                  Clacton and District Hospital. Nursing staff
                                                  were surveyed after three months about their
                                                  views on the training given and the operation
                                                                                                     N     ow that the one-stop dispensing
                                                                                                           scheme is well established,the next phase
                                                                                                     is to introduce a self-administration pro-
that, when the pharmacy is closed, the pre-       of the scheme.There were no negative com-          gramme.This, as in the acute trust, will allow
scribing doctor would take full responsibility    ments, and several nurses made positive            patients to be gradually introduced to manag-
for the accuracy of the “to take out” prescrip-   comments about the ability to give a more          ing their own medicines while still on the
tion but during pharmacy opening hours, a         flexible service to patients taking short leave.   ward. The programme will be co-ordinated
“fast track” clinical screen would take place,       The greater involvement of pharmacy             by the dispensary manager.
returning the prescription to the unit for the    staff in the mental health unit as a result of        The self-administration programme will
nurses to issue the medicines.                    the scheme has improved multidisciplinary          be another major culture change for staff at
   If medicines are altered during a patient’s    working relationships. The changes to the          the mental health unit. It will, however,
stay, the treatment card and the patient-         conduct of the medicine rounds have                enable patients to be trained about how to
specific box of medicines is returned to the      improved privacy and dignity for the               be responsible for their own medicines
pharmacy for a clinical screen. Redispens-        patients.This is an issue identified as impor-     before they are discharged. It will also allow
ing and relabelling is carried out as             tant in the National Service Framework for         staff to identify and resolve any potential
necessary.                                        Mental Health.1                                    risk issues in line with practices advocated
   At final discharge, all a patient’s medi-         After six months, the progress of the pro-      in the “Spoonful of sugar” document.2
cines are returned to the pharmacy                ject was presented to a meeting of senior
department, and the patient is given a 14-        managers and consultants of the trust. The         REFERENCES
day supply to take home. This is a                reception was positive. The trust’s manage-
long-standing policy of the mental health         ment executive committee subsequently              1. Department of Health. National
trust. Mental health managers were not            ratified the scheme and endorsed its adop-            framework for mental health: modern
willing to allow the remainder of a patients’     tion elsewhere in the mental health trust.            standards and service models for mental
medicines (ie, often more than 14 days sup-       This was recognition of the risk manage-              health. London:The Department; 1999.
ply) to be provided to the patient on             ment benefits of a formalised protocol             2. Audit Commission. Spoonful of sugar:
discharge, because of the perceived risk of       where specifically trained nurses are able to         medicines management in NHS hospitals.
abuse.                                            ensure that patients can take short rehabilita-       London:The Commission; 2001.

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