Government targets on daily pharmacist reviews for critical care patients are being missed in some Scottish hospitals owing to a lack of trained staff, a report has concluded.
The latest review by the Scottish Intensive Care Society Audit Group (SICSAG) — which describes the activities, interventions and outcomes for more than 46,000 critically ill patients who were treated in Scotland in 2020 — assessed intensive care services in Scotland on 17 “minimum standards and quality indicators” and found that four high dependency units (HDUs) were falling short on pharmacist reviews.
A patient care quality indicator requires all critical care patients to be seen by a critical care pharmacist (or “suitably trained” alternative pharmacist) on a daily basis to improve efficiency and safety.
However, the review says that HDUs at Victoria Hospital in Kirkcaldy, St John’s Hospital in Livingston, Ayrshire Maternity Unit and Queen Elizabeth University Hospital in Glasgow had not implemented this indicator.
Commenting in the report, NHS Fife said this was because Victoria Hospital was facing “ongoing issues with pharmacy shortage”.
“This issue has been raised previously; hospital management are aware of the risk involved from not having adequate pharmacy coverage of critical care but they feel they need to balance this risk across the whole hospital and are trying to recruit.”
The surgical HDU at Victoria Hospital was rated as not having implemented the indicator, with no plans to do so. Meanwhile, the medical HDU was reported to have plans “in place to implement [the indicator] in the next six months”.
The intensive care unit was rated as complying with the pharmacy review indicator “in some patients but not all”.
Benjamin Hannan, deputy director of pharmacy and medicines at NHS Fife, told The Pharmaceutical Journal: “Support to our intensive care unit is currently provided on a referral basis by senior clinical pharmacists.
“Furthermore, plans are in the final stages of development which will increase the support provided to our critical care teams and enable us to meet the Scottish Intensive Care Society standards.”
Elsewhere in the report, Queen Elizabeth University Hospital’s obstetric HDU said it had not implemented daily pharmacy reviews because it does “not have a dedicated critical care pharmacist for obstetric HDU patients” but added that this has been requested.
Outside of the SICSAG report, shortages of appropriately trained pharmacists have been highlighted in all sectors of pharmacy. The NHS Benchmarking Network’s ‘Pharmacy and Medicines Optimisation’ project reported in 2019 that the vacancy rate across hospital pharmacy in England “has increased year on year”.
Pharmacists were also included in the government’s shortage occupation list from 4 March 2021, making it easier for staff from abroad to successfully apply for a skilled worker visa through the UK’s immigration system.
Clare Morrison, director for Scotland at the Royal Pharmaceutical Society, said the SICSAG report “highlights insufficient pharmacy resource in critical care units, which is something that is recognised in NHS Scotland boards, particularly insufficient cover for weekends”.
“However, we understand that pharmacist staffing levels in critical care units are stretched right across the UK, not just in Scotland,” she said.
“During the COVID-19 pandemic, there has been work across NHS Scotland to increase training, capacity and expertise in critical care pharmacy services to increase service resilience.
“Although we welcome this work, further investment is needed to increase pharmacist numbers, especially at weekends.”
Morrison added that critical care pharmacists “would support a move to a seven-day pharmacy service if resources were in place to enable this”.
Claire Anderson, president of the RPS, added that the Society “would like to see three commitments taken to sustain the profession”.
“First, encouraging more people into pharmacy training to increase the number of pharmacists. Second, better retention of pharmacists in the profession through improved career development, working conditions and wellbeing. Third, smarter ways of working such as better use of technology and skill mix in order to release pharmacist capacity to focus on professional roles.”