The Innovating Works team at SCER (Findlay, McQuarrie and Briken) with colleagues from the Strathclyde Institute of Pharmacy and Biomedical Sciences (Professor Marion Bennie and Ms. Emma D. Corcoran) and the Department of Management Science (Dr Robert van der Meer) are contracted by the Scottish Government to evaluate technology-enabled change for the release of pharmacists’ time to deliver enhanced clinical care.
The adoption of technology into medicines supply/dispensing processes is not new. Yet the published evidence base is relatively weak given the potentially disruptive nature of these technologies and the significant capital investment required for their adoption.
In Scotland medicines are the most frequently used health intervention and account for approximately 15% of the total health budget. NHS Scotland spends over £1.5 billion annually on medicines with over £1billion spend in primary care (over 100 million items dispensed), the majority of which is delivered through the community pharmacy network (Alvarez-Madrazo et al 2016). However, although medicines have been shown to clearly improve patient outcomes they are also a cause of harm in both primary and secondary care with approximately 5-17% of hospital admission due to adverse drug events, a significant number of which are preventable. (Pirmohamed 2004; Gandhi et al 2003). While the incidence of patient safety incidents originating in community pharmacy is currently unknown, there is evidence to suggest errors with potential for serious patient harm are a problem (Knudsen et al 2007). Within the UK it has been estimated that there are approximately four dispensing errors and 22 near misses for every 10 000 dispensed items (Ashcroft et al 2005).
The Scottish Government Healthcare Quality Strategy (Scottish Government May 2010) recognizes the important role of medicines and includes a focus on effective treatments with no avoidable injury or harm, and eradication of harmful variation. Additionally, the Road Map to the 20:20 Vision for Health and Social Care (Scottish Government May 2013) makes a specific commitment within the domain of “Value and Sustainability” for the implementation of an Efficiency and Productivity Portfolio which includes a single programme management focus on medicines. Furthermore, the Scottish e-Health Strategy (Scottish Government May 2015) has safer medicines as one of its five strategic aims. This is endorsed in the Scottish Government’s vision and action plan for pharmaceutical care, Prescription for Excellence (Scottish Government Sep 2013).
Prescription for Excellence, published in 2013 set out a “Vision and Action Plan for the right pharmaceutical care through integrated partnerships and innovation”. This vision is that all patients will receive the highest possible care using the clinical skills of the pharmacist optimally and is a vision followed through in the 2017 strategy “Achieving Excellence in Pharmaceutical Care: a strategy for Scotland”. To achieve this goal there is a stated intent to explore technology adoption as a potential route to releasing time to care from routine technical processes encountered in the dispensing of medicines within the community pharmacy setting.
The adoption of technology into medicines supply/dispensing processes is not new. Yet the published evidence base is relatively weak given the potentially disruptive nature of these technologies and the significant capital investment required for their adoption. Scotland does, however, have experience of implementing a large scale automation of medicines distribution (hub and spoke model), as part of a hospital pharmacy service redesign programme in NHS Greater Glasgow and Clyde. The evaluation, led by SCER, focussed on how both the technology implementation/ operation and staff roles adapted and evolved as robotics technologies and supportive work practices became embedded over time and created different outcomes within and across occupations (Lindsay et al, 2017, and Lindsay et al, 2014). Importantly, this work highlighted how senior stakeholders could make real choices that aligned technological solutions, professional values and upskilled staff roles to support better patient care (Findlay et al, 2017).
This evaluation in community pharmacy provides an opportunity for Scotland to build on these and other experiences. The key aim of this evaluation is to provide evidence and insight to support the delivery of the highest possible quality of pharmaceutical care to all by using clinical and other pharmacy staff skills optimally, and to assess how this evidence can best support technology implementation of technology that maximises impact in relation to this aim. Key objectives focus on identifying current practices and metrics; the parameters of technology adoption; identifying the range of potential benefits of technology for multiple pharmacy stakeholders (eg using clinical skills of the pharmacist to their full potential and releasing them from final release activities, reducing error rates, and improving stock management); identifying the actors, factors and practices that support or obstruct the realisation of these benefits; and also any unintended consequences (for example in relation to emergent work practices, staff morale and perceptions of risk) arising from these technologies. Addressing these aims and objectives will provide robust insights for future technology implementation and practice and will support best practice in context.