meeting report
Individualised pharmacy services
– today and tomorrow
More than 1000 delegates attended the ADKA congress in Stuttgart in May 2018. Key topics included
the implementation of ward-based pharmacy services to improve patient safety, developments in
medicines preparation and discharge services
Laurence Goldberg
Independent pharmacy
consultant
Paul Le Brun
Frank Dombeck
Irene Kraemer
In 2015, the conviction of Neils H, a nurse
in Lower Saxony, for multiple murders of
hospital patients prompted the introduction of
measures to improve the safe and appropriate
use of medicines, according to Frank Dombeck
(Apothekerkammer, Lower Saxony, Germany).
As new measures were proposed, hospital and
pharmacy managers were forced to confront the
question, “Is having a ward pharmacist as an
established member of the patient care team
a logical development or an expensive luxury?”
he explained.
During the course of his trial in 2014, Neils H
told the court that after the first 50 cases he had
stopped counting., As time passed more evidence
came to light and in 2017, a further 84 murders
were investigated. The hospital was criticised for
its slow response and the call for ward pharmacists
to oversee and optimise prescribing grew ever
louder.
In 2015 an inquiry determined that monitoring
of pharmacy services was largely limited to matters
of ordering, delivery and storage of medicines on
the wards. Although satisfactory procedures were in
place they were not always followed – for example,
there were frequent breaches of prescribing
protocols and inappropriate storage of medicines.
It noted that as long as pharmacists were not
part of the patient care team, their role would be
limited to economic (cost) control of medicines.
The further removed from day-to-day patient care
the pharmacist is, the greater the danger that
communications are reduced to logistical aspects
alone, and this is likely to give rise to interface
problems. It concluded that the target of safe and
efficient use of medicines could only be achieved
when there is a multidisciplinary team of doctors,
pharmacist and nurses working on the ward.
The German Hospital Pharmacists’ Society
(ADKA) pointed out that Germany had the smallest
number of hospital pharmacists in all of Europe (in
Germany 0.31 pharmacists per 100 beds, and in UK
4.35, according to EAHP 2012). Furthermore, there
was a lack of medication safety in hospitals and this
could only be remedied by the implementation of
electronic prescribing and appointment of suitable
specialist pharmacists. Up until this time, hospital
pharmacists in Germany had been mainly concerned
with the supply of medicines, and in most hospitals
they had been largely confined to the pharmacy
department, a situation that made it difficult for
them contribute directly to the patient care process.
The regional government in Lower Saxony
decided to appoint ward pharmacists in all
180 hospitals in the region so that doctors and
pharmacists could work together to individualise
drug therapy and increase patient safety. The
foundations were then laid for a comprehensive
service that would see the ward pharmacist as
an integral member of the patient care team
and medication use process. This would include
recording of medication histories and medicines
reconciliation, monitoring of prescribing and
provision of information to patients. Linked with
these developments was the recognition that
medication errors not only harmed patients but also
cost the healthcare system greatly. “Some 20% of
about 20 million emergency hospital consultations
are due to medication side effects or unwanted
effects”, noted Dr Dombeck. Moreover, several
studies had shown that about 25% of adverse drug
events responsible for hospital admissions were
avoidable, he continued.
Now it is recognised that ward-based pharmacists
can make an important contribution to medication
safety in hospitals and that they should be members
of multidisciplinary patient care teams. Their
role is not only concerned with saving money
on medicines but also with improving the safe
and economic use of medicines and optimising
Now it is recognised that ward-based
pharmacists can make an important
contribution to medication safety in
hospitals and that they should be
members of multidisciplinary patient
care teams
therapy. The responsibilities and tasks of a ward-
based pharmacist make the role attractive to young
pharmacists and those entering the profession,
he said.
The path to improved hospital pharmacy services
in Germany has not been smooth. As far back as
1990 a pilot study in Braunschweig (Brunswick)
Hospital demonstrated the value and effectiveness
of a ward-based pharmacy services and received
the endorsement of the hospital medical director
who said the service should be introduced
throughout the hospital. However, “that which
is long in the making eventually comes good”,
concluded Dr Dombeck.
Preparation of medicinal products
The preparation of medicinal products in hospital
hospitalpharmacyeurope.com | 2018 | Issue 90 | 45