blog.gov.jeWhere is the Hospital Pharmacy?
The Hospital Pharmacy is based in the corridor between the Outpatients Department and The Parade entrance of the General Hospital.
Who is using the Hospital Pharmacy?
The Hospital Pharmacy is used by all Islanders who have been provided a prescription by Health and Community Services. You don’t need to pay for your medicines, unless you have a private prescription.
The Pharmacy Department also provide a wide range of services to Islanders. This includes a clinical service to patients in the general hospital as well as mental health; bespoke production of chemotherapy for cancer patients in a specialist ‘aseptic’ unit; purchasing and distribution of all medicines for patients who use HCS services and dispensing services for all inpatients and outpatients.
Pharmacists are experts in medicine-use handling and all pharmacy staff work extremely hard to ensure Islanders get the best from of their medicines. At the very heart of this is making sure medicines are safe for patients. In short, the Pharmacy ensure that medicines are used safely, effectively and provide the best value for Islanders.
What are the opening times of the Hospital Pharmacy?
The pharmacy is open to the public Monday to Friday from 9am to 5pm. Additionally, pharmacy staff are working to provide services to inpatients on Saturdays and Sundays. There is also an ‘on-call’ pharmacist who provides expert advice and emergency supplies for inpatients outside of working hours.
The Pharmacy experiences a higher volume of outpatient prescriptions between 12:00 – 14:00, and so Islanders are recommended to avoid these times if they can.
The Hospital pharmacy closed to outpatients on weekends, from Saturday 2 September in a change which the Government of Jersey said would help it focus on inpatients.
How many items does the Hospital Pharmacy dispense a day?
The Pharmacy dispenses around 800 items a day, with 150-250 people attending at the outpatient pharmacy every working day. Over a month the pharmacy typically dispenses 16,000-18,000 items. This is much more than a typical community pharmacy.
Most medicines provided from the hospital pharmacy will be new for a patient, because repeat prescriptions should normally be dispensed by a community pharmacy after a GP prescription. The processes are also more complex than most community pharmacies, because of the nature of patients and medicines involved, with frequent need for discussions with a prescriber to ensure a prescription is safe and is therapeutically appropriate.
Why can community pharmacies not process hospital prescriptions?
Community pharmacies can process hospital prescriptions; however patients will be charged a private prescription fee for this. This is because hospital prescribers do not have access to the Health Insurance Fund, which is administered by Government of Jersey Customer Local Services – under the Health Insurance Law.
How long does it take a patient to wait for their prescription?
Wait times are, of course, variable depending on the time or balance of capacity vs workload at the time.
Typically, the waiting time is about 45 minutes to an hour, sometimes less, sometimes more.
Why not open 2 hatches (one for drop off, one for collection):
When we have capacity, we aim to have two pharmacy assistants at the hatches; we have listened to patients comments. An example of improving efficiencies is the drop off box, which is open 24 hours, and allows to ease the flow of patients wishing to hand their prescriptions in.
If returning 2 days later to collect, they still have to queue.
It is the same staff handling all aspects of the dispensing process. These staff will be pharmacy assistants and pharmacy technicians. There is also a pharmacist based in the dispensary who will ensure that the medicines prescribed are safely and effectively for every patient. Medicines need to be handed to the right person, and some will need further advice to be discussed with the patient.
Why does it take some time to match a receipt to a prescription?
There are lots of things that can mean it is less simple than collecting a completed prescription from the shelf. Sometimes it requires collecting information from more than one place.
- In some cases, a prescription will not have been prepared in advance. This will happen for products that are frequently not collected – for example, bowel preparations. It may be a controlled drug (CD) – for example a narcotic – requiring a double person checking process to get it out of the CD cupboard and make the legal records. It may require checking on the electronic tracking system to identify where in the process the item is.
- Some or all of the prescription may require cold chain storage – so this will be stored in the fridge.
- Some prescriptions have a limited shelf life once prepared (e.g. antibiotic liquid), which means this cannot be prepared in advance. Some prescriptions are complex and require careful and precise manipulations to ensure that the patient receive their medication safely. For example, prescriptions for cancer patients and babies.
What options do Islanders have when submitting their prescription?
Islanders can drop off their prescription by leaving it in the prescription drop box, which is open 24 hours, and located in front of the Pharmacy counter. Medicines will be ready for collection from the Pharmacy desk approximately 24 hours later.
Islanders can wait to hand in their prescription and wait for their medicine, which could approximately 45 minutes. There are two waiting areas that are now fitted with pharmacy screens which notifies patients when their medicine is ready at the counter for them. The waiting rooms can be found outside of Pharmacy and a larger more comfortable are in the Outpatients waiting room, approx. 15m away.
There are toilets and a children’s play area available in the general outpatient waiting area. Food and drinks are also available to purchase nearby in the Thyme Out Express.
When I return (after I am advised by the screen, or two days later) do I still have to queue for to collect – is this being addressed?
Medicines must be handed to the right person, and some will need further advice to be discussed with the patient. Reducing the number of people who need to queue to hand in prescriptions will help with this.
How are you helping patients who don’t wish to wait to hand in their prescription, or wait to collect their prescription?
Along with the drop box (to the left of the hatches at the Pharmacy), we have now installed a screen in the outpatients waiting area, that shows people waiting there the status of outpatient prescriptions. It does not yet provide an audio call for those prescriptions ready for collection, but we hope this will be available soon.
If you are a hospital admission, is it quicker to ask a nurse to submit your prescription by tube, or to take your prescription to the desk yourself?
Clinical pharmacists and technicians visit inpatient wards on a regular basis to ensure patients are prescribed the right medicines for them. They will help support the process of discharge in relation to medicines. Before a discharge prescription can be processed, it needs to be prescribed. Most inpatient areas now operate with an electronic prescribing system which means that there will be no need to send hard copies of prescriptions – via the pneumatic tube, or any other way. The prescription will be delivered electronically. Prescriptions for inpatients will be delivered to ward areas and patients are not expected to deliver or collect prescriptions themselves.
Why can community pharmacies not process hospital prescriptions?
Prescriptions written by GPs are dispensed by community pharmacies; more information can be found here. Only Health and Community Services prescriptions are dispensed by the hospital pharmacy.
What other things are being considered to speed the process up?
We are about to trial having phone calls accepted by an admin member of staff, because most calls are simply asking if their prescription is ready, interrupting the very people trying to prepare them. This is both disruptive, and counterproductive, so our trial will help identify whether that’s an additional role that will be worth trying to incorporate into the department. We are also continuing to review other processes to see where we can make time savings.
What are the factors impacting on our waiting times?
The main factor is the mismatch between our capacity and the demand. Outsourcing some demand would help bring that mismatch closer to balance. It is, of course, not a quick solution, because it requires several governance and financial steps to be completed and agreed. Additionally, this may mean a change in the Law.
What happens to prescriptions not collected within 2 weeks of being requested?
If the prescription was originally handed in more than 2 weeks ago (and there are a lot of these, unfortunately), it may be in a box waiting to be returned to stock, because we no longer anticipate it will be collected, or it may be already returned to stock and then require re-dispensing.
Who is who in the pharmacy department?
In addition to our Dispensary team, the Hospital Pharmacy deliver 4 key services to Islanders. These are Clinical Pharmacy Services; Aseptic Pharmacy Services; Dispensary Services and Procurement & Distribution Services. These services are supported by 3 key functions – Digital Pharmacy Services, Medicines Governance and Training.
Our dispensary Team is made up of a variety of staff, reception staff, pharmacy assistants, pharmacy technicians, and a pharmacist. They will be receiving the prescriptions, logging them on to our tracking system, then assembling and checking medicines ready for supply to a patient, with the pharmacist screening all prescriptions to ensure that the medicines prescribed are safe and appropriate for each patient. Medicines may need to be ordered, if not held in stock, and there are often clarifications required from the prescriber, to ensure the right medicine, and form of medicine is supplied. Medicines need to be handed to the right person, and some will need further advice to be discussed with the patient. Medicines counselling will be done by a pharmacy technician or a pharmacist.
Our Clinical Pharmacy team spend most of their time supporting doctors, nurses, and patients on the wards (and with outreach services) to make sure that medicines prescribed are appropriate, safe, and available for the patients to receive. They make very many adjustments to support this, with major interventions preventing harm, on a regular basis.
Our Procurement team are responsible for purchasing all the medicines used within Health and Community Services – for outpatients, inpatients, the production of intravenous chemotherapy and also for mental health. They ensure that medicines are procured safely, are of the right quality and are of best value for the taxpayer. There are approximately 4000 different lines of medicines which are procured by the Hospital Pharmacy. They also make sure that the medicines we do hold are kept in ideal storage conditions, (cytotoxic, temperature sensitive, robot) that ensure they will be effective when supplied to patients.
Our Aseptics unit, provides intravenous infusions for cancer patients, and intravenous feeding bags, that are essential to the effective treatment of our cancer patients in the hospital and other inpatients. The pharmacy staff are involved in discussing appropriate dosing, making products in a safe, sterile environment that can then be administered by nurses. We now have a pharmacist prescriber who has recently qualified in this area.
Our digital team work on making sure our electronic systems for medicines (such as the Electronic Prescribing and Medicines Administration system (EPMA) work effectively and are used in an increasing number of settings across the hospital, to minimise many of the risks of medicines use in a hospital.
A training function help us keep up to date with the changing pharmacy, again a tiny but dynamic team, supporting the development of current and future pharmacy professionals in the department.