Medicines advice out of hours: exploring the opinions of healthcare professionals on the use and provision of on-call pharmacy services in England

Abstract

Provision of NHS hospital pharmacy services has historically been delivered during typical ‘office’ hours. During these hours most pharmacy departments provide a medicines information (MI) service where any healthcare professional can ask for medicines advice. Outside of these hours questions are handled by an on-call pharmacist. This study aimed to investigate the provision of pharmacy services and medicines advice out of hours, from the perspective of pharmacists and other healthcare professionals, in NHS England.
A mixed methods approach was used: an online survey of all Chief Pharmacists in England (2012: n=220) and semi-structured interviews of on-call pharmacists (2014: n=8) and doctors and nurses (2015: n=3 & n=4 respectively) in the East of England. The online survey provided information about the provision of on-call pharmacy services in England, documentation of calls handled, and provision of relevant training. Semi-structured interviews generated 19 themes, grouped into 5 meta themes: documentation, individual’s knowledge and experience, information accessibility, use of service, and awareness of service.
On-call pharmacy services were provided by most hospitals, predominantly by less senior staff with limited years’ experience. Documentation of questions was variable, and less than half of Trusts had a documentation policy. Documentation by on-call pharmacists was found to be affected by their knowledge and experience, if they had any concerns about the enquirer’s understanding, the time the call was received, and remuneration and Information Technology (IT) issues. Both Chief Pharmacists and on-call pharmacists identified that training mainly consisted of operational issues, with on-call pharmacists believing a greater role could be played by MI staff in this training. Drug administration and ‘medication safety check’ were the main types of medicines advice questions sought out of hours. Chief Pharmacists stated on-call pharmacy services were well advertised but doctors and nurses seemed unaware of its provision and means of access; on-call pharmacists perceived this to be due to a lack of promotion. Access to information out of hours, particularly patients’ drug and clinical information, by on-call pharmacists was a barrier to providing medicines advice.
This is the first insight into the national landscape of on-call pharmacy services. There is a clear role for MI services to support on-call pharmacy services, and national standards should be developed for provision, information accessibility, documentation and training. National pharmacy policy makers could also consider structured training, repeated on a regular basis, for all on-call pharmacists.