By Samrina Bhatti, MRPharmS, PGDipGPP, Manager, Centre for Health Solutions

COVID-19 has been a powerful stimulus in catalysing the use of technology. This has led to digital technologies becoming embedded more than ever in our everyday lives and, importantly, within healthcare roles. As a result, the digitalisation of healthcare practices and the amount of data held within electronic health records is growing exponentially. However, we are still catching up on methods of optimising the use of all of this data and generating actionable insights. As a pharmacist who has worked both locally and nationally, I have seen the positive effects that increased digitalisation can have on prescribing and administration practices.

The NHS has acknowledged the benefits of digitalising pharmacy processes:

• NHS Improvement’s Medicines Safety Improvement Programme was established, to support the development and implementation of various digital initiatives, including ‘PINCER’, a pharmacist-led IT-based intervention to reduce clinically important medication errors in primary care.¹
• In October 2018, a working group, led by the NHS England Chief Pharmaceutical Officer, identified several types of data that could improve care, included prescribing and dispensing information, and patient outcomes data.²

The challenges to digital transformation across the pharmacy profession

The true potential of digital transformation in pharmacy across primary and secondary care is yet to be unlocked, particularly the use of integrated prescribing and administration data. The challenges facing the pharmacy profession are no different to the challenges facing the healthcare workforce identified in Deloitte’s report Closing the digital gap: Shaping the future of UK healthcare.³ These include:

• lack of education and training on digital technologies, as shown by surveys of early career pharmacy professionals, including students, with most respondents (87.3 per cent) feeling they lacked education and training in the area of clinical informatics⁴
• healthcare interoperability, while extremely complex, relies on being able to establish connectivity and secure communication of data between multiple and often disparate IT systems, that are often structured in a way unique to each provider⁵
• lack of information sharing across all providers including hospitals, GP surgeries and community health services, resulting in incomplete medicines related information⁶
• staff resistance to behavioural and cultural change in adopting and implementing digital solutions.

Optimising pharmacists use of prescribing data

More than one billion prescriptions are dispensed in community pharmacies annually.⁷ In addition, £9.2 billion was spent by hospitals on medicines in 2017-18.⁸ This generates a vast amount of medicines data across various systems including Summary Care Records, patient medical records and electronic prescribing in both primary and secondary care. In general, rich data on primary care prescribing has been available for some years and a national prescribing data collection system allows tracking of prescribing variations. However, only limited data on hospitals’ use of medicines exists.⁹

Additionally, data is available mainly through authorised access on various NHS and independent platforms including: ePACT2, Rx-Info Define, Public Health England FingerTips, OpenPrescribing.net, PrescQIPP and NHS England RightCare.¹⁰ In order to make best use of this data, it is essential that pharmacy professionals are sufficiently trained and competent in using these datasets to optimise patient outcomes. Particularly in the long term, where genomics and personalised medicine will become more widespread.¹¹

Schools of Pharmacy and other national bodies such as the Centre for Pharmacy Postgraduate Education have recognised the need to understand the role of data in healthcare, and are developing training courses. Furthermore, support to upskill the pharmacy workforce in clinical informatics is increasingly available by the NHS Digital Academy and the Faculty of Clinical Informatics.

Using digital technologies to reduce administration errors

An estimated 237 million medication errors occur in the NHS in England every year.¹² Of these, 54.4 per cent are administration errors across all settings.¹³ Adverse medication events can lead to increased length of hospital stay, healthcare costs, patient morbidity and mortality. Studies have found medicines administration error rates in hospital to be between 10.5 and 19.7 per cent.¹⁴

To investigate the use of optical and barcode scanning of medicines to reduce these medication errors in hospitals, I led a national scoping exercise, on behalf of the Medicines Optimisation Digital Learning network, for closed loop medicines administration (CLMA). The process for CLMA is illustrated below in Figure 1.

Figure 1. Process of closed loop medicines administration using barcode scanners

Source: Medicines Optimisation Global Digital Exemplar Learning Network

In my national role, I led a series of engagements with NHS hospitals, including a number of workshops, which resulted in the development of a national toolkit, to share the lessons learned in implementing CLMA.¹⁵ My research highlighted that with the traditional method of administering medicines, staff are not always aware that an error or near miss has occurred at point of administration.¹⁶ A growing body of evidence demonstrates that medication errors can be minimised using CLMA by addressing the ‘five rights’ of medicines administration (see Figure 2).¹⁷

Figure 2. ‘Five rights’ of medicines administration aligned through closed loop medicines administration
Source: Medicines Optimisation Global Digital Exemplar Learning Network

Catalysing the future of digital transformation in pharmacy

Digitising healthcare networks will allow us to harness and leverage innovation to improve health outcomes. In 2019, I conducted a national survey on behalf of the Specialist Pharmacy Service, to review the use of digital communications across the Medication Safety Officer network, most of whom are pharmacists.¹⁸ Respondents agreed that digital communications through webinars and online forums can facilitate networking but that this requires a robust IT infrastructure to enable ease of access, in all sectors.¹⁹ User friendly digital platforms can enable network members to engage and interact more readily, as well as allowing staff to access more timely information.²⁰

While technology is a critical enabler to transform ways of working, sharing knowledge and insights from medication prescribing and administration, collaborative working is essential. Indeed, it has never been more important, given the urgency and attention that is currently being applied to develop treatment solutions for the global COVID-19 pandemic. The current fragmented digitalisation of pharmacy processes need to be addressed urgently. A system wide approach linking primary, secondary and tertiary care communities is an imperative across pharmacy and the wider healthcare professional teams. While this will be challenging, stronger collaboration and communication across the system to share and adopt best practice at scale, will help.

Therein lies the question, given COVID-19 has led to the accelerated use of digital technologies across many aspects of healthcare, will it is also be the catalyst for the digital transformation of the pharmacy profession? Moreover, given the NHS’s response to COVID-19 has highlighted a number of challenges that need to be addressed across all care settings, where in the list of priorities will this digitalisation of pharmacy lie?

Samrina Bhatti, MRPharmS, PGDipGPP, Manager

Sam is a national award-winning pharmacist with local, national and international experience. Prior to joining the Centre, Sam was working alongside the Chief Pharmacist at Bart’s Health delivering trust-wide projects in service development and implementation. Prior to this Sam was the NHS England Chief Pharmaceutical Officers’ Clinical Fellow at Specialist Pharmacy Service, where she led various national projects on medicines use and digital healthcare. Sam is part of the global commonwealth health partnerships, an NHS England Clinical Entrepreneur, and a pre-doctoral fellow at Health Education England undertaking a PGCert in Healthcare Research Methods. Sam is also an associate of the Faculty of Clinical Informatics and Institute of Healthcare Management and has a Master of Pharmacy from King's College London and Diploma in General Pharmacy Practice.

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¹ https://www.sps.nhs.uk/articles/nhs-england-report-supporting-early-career-pharmacy-professionals-in-data-driven-care-a-guidance-document-for-the-professionals/
² https://improvement.nhs.uk/resources/national-medicines-safety-programme/
³ https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-life-sciences-health-care-closing-the-digital-gap.pdf
⁴ https://www.sps.nhs.uk/articles/nhs-england-report-supporting-early-career-pharmacy-professionals-in-data-driven-care-a-guidance-document-for-the-professionals/
⁵ https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-life-sciences-health-care-closing-the-digital-gap.pdf
⁶ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279871/
⁷ https://www.pharmaceutical-journal.com/news-and-analysis/news/number-of-prescriptions-dispensed-by-community-pharmacies-tops-one-billion-for-first-time/20203926.article
⁸ https://files.digital.nhs.uk/7D/7DFB32/hosp-pres-eng-201718-execsum_v2.pdf
⁹ https://www.kingsfund.org.uk/sites/default/files/2018-04/Rising-cost-of-medicines.pdf
¹⁰ https://www.sps.nhs.uk/articles/nhs-england-report-supporting-early-career-pharmacy-professionals-in-data-driven-care-a-guidance-document-for-the-professionals/
¹¹ https://www.pharmaceutical-journal.com/news-and-analysis/opinion/blogs/data-driven-care-why-pharmacy-needs-to-get-involved/20206874.blog
¹² http://www.eepru.org.uk/prevalence-and-economic-burden-of-medication-errors-in-the-nhs-in-england-2/
¹³ https://www.pharmaceutical-journal.com/news-and-analysis/infographics/medication-errors-where-do-they-happen/20206204.fullarticle?firstPass=false
¹⁴ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3688612/
¹⁵ https://future.nhs.uk/connect.ti/MedsOPDigitalLN/view?objectID=15208880
¹⁶ https://www.pharmaceutical-journal.com/opinion/blogs/adoption-of-closed-loop-medicines-administration-into-the-nhs/20206864.blog
¹⁷ https://www.england.nhs.uk/digitaltechnology/connecteddigitalsystems/exemplars/gde-blueprints/
¹⁸ https://rxmagazine.org/how-effective-is-digital-communication-within-the-medication-safety-officer-network/
¹⁹ Ibid.
²⁰ Ibid.