I welcome the reports from your journals relating to hub-and-spoke dispensing (
The Pharmaceutical Journal 2016;296:205) and electronic prescribing (
Clinical Pharmacist 2016;8:144) as valuable contributions to transformation of distribution and supply of medicines and the benefits to patient safety from e-prescribing, respectively. Although the former article focuses on community pharmacy and the latter on hospital pharmacy, from a project we are carrying out at the University Hospitals Leicester NHS Trust (UHL), it is our view that these two issues can be co-joined in hospital pharmacy to exploit fully their potential.
Both articles show how transformational change can positively impact on workflow and error reduction. At UHL, our OptiMed-ID project incorporates e-prescribing with the supply and distribution of unit-dose medication for hospital inpatient use. This is based on experience in Italy where, from a central hub, unit doses are able to be supplied to wards in hospitals up to 200 miles away in a timely and efficient manner while also improving patient safety. These findings are similar to those reported in your journals mentioned above.
Although the UHL project is continuing, the Italian experience, combining hub-and-spoke delivery together with e-prescribing, can be replicated in the UK. Results in UHL to date show a reduction in expenditure across the four pilot wards of 17% because of logistical efficiencies (calculated using the Laspyere’s economic model), a reduction of 40% in inpatient dispensing, a 71% reduction in medicines waste, a 55% reduction in stock lines carried in ward cupboards and a 42% reduction in duplicated medicines supplies because of patient movement or “lost” supplies.
From a medicines safety perspective, we have also seen a 1.2% error rate because of medicines not available compared with previous audits showing in excess of 10% (Loughborough University evaulation report, available from me). The OptiMed-ID system delivers reduction in medicines waste and staff time involved in supply and distribution while achieving improvements in patient safety and significant overall savings. This is consistent with delivering recommendation 3 in Lord Carter’s report, ‘Operational productivity and performance in English hospitals: unwarranted variations. February 2016’. The hub-and-spoke model also facilitates the hospital pharmacy transformation programme, a key driver for change in Lord Carter’s report, by hospitals collaborating to deliver inpatient supplies, freeing pharmacist and technician time for medicines optimisation duties.
I would therefore urge readers not to look at the hub-and-spoke model solely in the context of community pharmacy. In addition, the connectivity between e-prescribing and hub-and-spoke medicines supply should be examined in hospital pharmacy to exploit patient safety opportunities, together with improving the efficiency of medicines supply and distribution, and release of pharmacy staff time for other duties.
Associate chief pharmacist, chief pharmacy information officer
University Hospitals Leicester