The role of pharmacy in Hospital at Home


Pharmacy is an important element of Hospital at Home (H@H). Aoife McGrath, Clinical Pharmacist, Acute Care at Home Team in the Belfast Trust, shares her story.

Joining the H@H team

I have been a pharmacist for 16 years. After seven years of working in the community, I wanted to gain some hospital experience, so I accepted a job with the Belfast Trust and began moving across different wards and various aspects of the hospital. When I heard that the Acute Care at Home team (H@H) was being set up in 2015, I really wanted to be involved - in my pre-registration year at university, my dad has sadly passed away on a care of the elderly ward. I really loved the idea of older people being treated in their own home, surrounded by their family, with hospital services being brought to them, which is what led me to thinking that this is the job for me. And that’s what I have been doing since 2015! I am the sole pharmacist in the Acute Care at Home team, which I love, and intend on staying here for years to come.

Understanding the differences between H@H and hospital

While the core pharmacy standards apply no matter where you are, whether in a community or at a hospital, working in a H@H setting is very different, as you don’t have the physical structure and comfort of the hospital building. Patients are not in neat rows with their notes kept in one place on the ward. Staff are not in the one building at one time. You don’t have ingrained processes and guidelines that become second nature to staff.

As the sole pharmacist, I was responsible for designing and writing the guidelines and determining best practice, aimed at achieving optimum patient safety in a home environment. Our local policies needed to be tailored to H@H and there was no point in trying to make the hospital-based policy work for a team that didn’t even exist when the policy was written. I needed to design pragmatic protocols that truly worked for the patient and the team.

In terms of the skills you need for a H@H environment, I would say that being confident in your own ability and negotiating skills is absolutely critical (you also have to have the confidence to drive through busy cities, or the winding countryside, even when the weather is terrible!). Once you’re in someone’s home, you also have to remain adaptable - you don’t have a nice ergonomic workspace, you have to get good at perching, kneeling and squatting, all the while still looking professional.

Embedding pharmacy into H@H teams from the beginning

Joining a team at its inception is a great place to start in your H@H journey, as it gives you the opportunity to build solid foundations, often those you might not even realise you need, like drug storage, drug labelling and dispensing, drug label templates, how to transport drugs and oxygen, what you’re going to prescribe, how you will get the prescription to pharmacy and then to the patient, and so on. Reviewing legislation and designing Standard Operating Procedures (SOPs), then testing the SOPSs to make sure they work and training staff on how to use them is also best done when at the very beginning, so that you can build trust with the team. By coming in at the start, you are integral to building processes, instead of coming in halfway and having to tell the team things that they have got wrong. 

How pharmacy input can improve H@H care

While appraising my work, I contacted the medical team to ask what the advantages or disadvantages were of having pharmacy involved in a H@H team and I got a very encouraging response from our lead consultant, who highlighted the following benefits to me:

  • Really good medicines reconciliation and rationalisation as part of the geriatric assessment, helping with a quality assessment of older people as soon as they start with H@H team.
  • Patient support and education in a real life setting. In a person’s home, you get a full picture of how a person is managing their medicines.
  • Helps drive and develop the H@H service overall, providing SOPs for new treatments and safe supply of medicines.
  • Communication improves with a pharmacist there. There are lots of people that need to be involved, like families, carers, a practice-based pharmacist or other hospital groups. The pharmacist helps make the connections and has lots of good links with community pharmacy.
  • Pharmacists often know the mysterious ways of the blister pack!

H@H Pharmacy Network

I had been working as a sole pharmacist since 2015, so I made sure to reach out to colleagues across Northern Ireland, but we are still few in number. This role can feel quite isolated and sometimes I am faced with uncomfortable situations, so I thought if this was happening to me, it might be happening to other people as well, which led me to wanting to reach out to see how we could make it better together. Which is how the H@H Pharmacy Network was born.

It’s a very new network – formed in 2021 and very small, but we are hoping it can expand and currently have representatives from Northern Ireland, England, Scotland and Wales. At the moment, it is a support and learning network, a sounding board for each other, which provides opportunities to share good practice across different areas. So far, it is working really well! What we found is that no matter what the team is called, where the team is, what the requirements are, the problems are often the same and we can come together to help each other out.

You can contact the H@H Pharmacy network by emailing aoife.mcgrath@belfasttrust.hscni.net, or phone 07860179493.

Key takeaway from H@H

My takeaway for commissioners is simple - you may not think you need a pharmacist and that it’s expensive, but it is absolutely worth it. An experienced pharmacist can help the team thrive. You need the right pharmacist who is pragmatic, adaptable, can communicate, passionate about elderly care and who loves writing SOPs.

For H@H colleagues, I am guessing you are probably under resourced and your head is spinning about where to start and how to improve patient safety and care. But focus on quality, select a small patient group based on your risk assessment or locality, and really give the gold standard pharmacy service so you can demonstrate worth that way. It then becomes very obvious very quickly that quality will shine through.

It can be quite a different role, but a lovely one nonetheless.