I am Diane Meech, I work as the Principal Pharmacy Technician in the role of Homecare Lead, at the Royal Brompton Hospital. Our patients come from all over the UK, and we need to ensure they receive ongoing supplies of the medications initiated by the hospital clinicians. Outsourced providers are contracted to provide a dispense and delivery service, direct to the patient’s home, with their consent of course. The purpose of the homecare medicines service is to improve patient care and choice of their clinical treatment. Homecare services are provided to over 200,000 patients in the UK representing £1.5 billion of the £4 billion spent on hospital medicines.
I am normally at work by 8.20am, underground allowing! As I pass through the dispensary, I collect the homecare prescriptions for the outpatients, prescribed home iv antibiotics. This service requires a fast turnaround, patients are supplied with the first 24-72 hours of medication from the hospital pharmacy, the remainder of their course is delivered by one of the homecare companies. I check the information is clear in preparation for my team to raise a homecare request (like a purchase order). When invoices are processed, the delivery and invoice is crossed checked against the homecare request, in the same way goods are checked against purchase orders in the pharmacy stores.
The specialist teams screen their own prescriptions and then hand them over to the hub for ordering and posting. All prescriptions are batched in a wallet by speciality and homecare provider. I have designed a checklist, so we know which company to send the prescriptions to and how soon they need to be posted. The checklist is signed by the company staff and emailed back to us, so we know they have arrived safely.
As the homecare hub team arrive, I discuss the workload and priorities for the day. We are currently training one of the pharmacy assistants, so I ensure there is one of the team to support them and they have the relevant SOP to refer to. All procedures are reviewed in line with the RPS standards for homecare.
All homecare requests should be raised by 11am in order that myself and the rotational homecare pharmacist can check and release the requests by 1pm. After lunch the prescriptions are scanned onto the electronic patient record and placed in prepaid envelopes with the checklist.
I quickly check emails and allocate each to the relevant person to action. I action the response to a patient incident recently reported. I review the investigation report sent by the provider and update the trusts incident reporting system with the outcome of investigations and preventative actions, I also inform the specialist pharmacy team.
The phone rings, an anxious patient tells me, that they only have one day of their medication left and no delivery arranged. I reassure them and can confirm there is a current prescription open. I contact the relevant provider to ensure they call the patient and make a next day delivery. It turns out the patient had changed their mobile and not told the provider, so could not be contacted.
I start preparing the agenda and papers in advance of the trust’s homecare governance meeting. The group has oversight of all issues relating to the homecare services, including approval of new services. I provide a summary of the issues identified as part of the provider quarterly review meetings held with each of the companies we use. I note that one key contract is due to expire next year. The service specification will need to be reviewed and a tender carried out to select a supplier.
I finish my lunch early to reach the meeting room, in time for the contract review meeting. Having reviewed the KPI data, I raise the issue of an increase in delivery and outstanding invoice value. This turns out to be several longstanding invoice queries. We also review the complaints and incidents for emerging trends or new issues.
Back in the office, I make sure all the prescriptions have been posted. I check and authorise the mornings batch of invoices for payment. Armed with a tea I then review a revised SOP. We have identified some problems so changed our processes. It is gone 5.30pm and time to finish for the day.
Diane Meech – Principal Pharmacy Technician – Homecare Lead