Information summary - pharmacy

All Hospital at Home (H@H) services in Scotland operate in a unique way, while following the key elements laid out in the Guiding Principles document 

For a better understanding of what this means for the different services, we have pulled together the relevant information about pharmacy in their services. The data are taken from the information sheets that were provided by the services, originally in October 2022.  

The information in this document was accurate at the time of publication but as services evolve, the information will change. This document will be reviewed and updated annually.

 

Which members of your team can prescribe?


Aberdeen City

  • Advanced nurse practitioners (ANPs) 
  • Nurse practitioners (NPs) 
  • Consultant 
  • Medics 
  • GP, and 
  • SAS (who are prescribers) 


Dundee City

  • ANPs, and 
  • Geriatricians  

Glasgow City

  • ANPs 
  • Pharmacist 
  • GP with special interest (GPwSI), and 
  • Consultant geriatrician
     

Fife

All registered nurses who have completed the non-medical prescribing training can prescribe. Staff nurses within the team use Patient Group Directions (PGDs) for relevant medicines. 

Forth Valley

  • All doctors 
  • ANPs, and 
  • Some NPs who have completed prescribing training. 
     

Moray

  • ANPs 
  • Consultants 
  • Band 6s cannot currently prescribe. 


Lanarkshire

Some of our Band 6 NPs can prescribe as well as our consultants. 
 

Perth and Kinross

  • Presently the Specialist GP. Nursing staff are currently undertaking their V300 training. 
  • Service manager for urgent care is progressing discussions about a prescribing budget.
     

Lothian

Midlothian 

  • All medical staff 
  • Pharmacy staff, and 
  • Band 7 ANPs. 

Edinburgh  

  • All medical staff.  
  • Pharmacy staff. 
  • All Band 7 ANPs have completed their non-medical prescribers course with one awaiting a prescribing number.  

Several of our Band 6 NP team have recently completed their non-medical prescribers course and are prescribing or awaiting their prescribing number. It is our intention to encourage all NPs to complete this course.  

West Lothian 

  • All medical staff 
  • Pharmacist, and  
  • Four NPs 

East Lothian 

All medical staff and all Band 7s. 

Western Isles

  • Band 7 nurse, and 
  • Band 6 nurse 

 

Do you have a pharmacist as part of your team or an agreement for pharmaceutical input/advice?


Aberdeen City 

Have a bank pharmacist (non-prescriber). 

 
Dundee City 

We have agreed pharmacy input. The pharmacist attends a ward round once weekly and is on call for advice via beeper. 

 
Glasgow City 

Yes, a qualified pharmacist and pharmacy assistant.  

Fife 

The H@H teams all have pharmacy input from pharmacists and pharmacy technicians however not daily. 


Forth Valley 

We have links with pharmacists in other teams. 

 
Moray  

We have a link with pharmacists who are based in GP surgeries or with the hospital pharmacy team. We currently have to go through the GP to prescribe in the community which can cause delays. 

 
Lanarkshire 

No, we are currently trying to secure funding to include pharmacy resource within our service. 

 
Perth and Kinross 

  • Recruitment to H@H pharmacist and pharmacy technician is ongoing. 
  • We are supported by a pharmacy technician daily as and when required. We also liaise with the lead pharmacist for Perth Royal Infirmary as required.  

 
Lothian 

Midlothian  

We previously had a part time pharmacist and found this role to be extremely valuable. This post was vacant for three years but has now been recruited to. 

Advice can be sought from the community pharmacists, working in the GP practice or from Midlothian’s lead pharmacist. 

Edinburgh   

Additional funding has been approved by Healthcare Improvement Scotland to enable increased pharmacy support. 

West Lothian  

Yes, although our pharmacist also covers three community hospitals. 

East Lothian 

Yes, input to the team two days per week to H@H, plus can access advice from Hospital Pharmacy team out with this. 


Western Isles 

No pharmacist in the team but have access to the hospital pharmacy. 

 

What practical processes have you put in place for prescribing new medications, stopping medications and changing existing ones?


Aberdeen City 

Medical reconciliation (med rec) form 

Dundee City 

All patients who are admitted have a drug kardex completed which sits within their admission notes. This makes it transparent to see any current or new medications that have been started or stopped. 

We have a stock of medication to take out and a prescription pad for the service. If medication is required we will provide this from our stock or issue a prescription. We will log any medications or prescriptions issued.  

With any new admission we discuss medication with our Pharmacist at the huddle and review if we need to start, stop or reduce certain medications. This is a shared decision making process involving all team members and discussions with the patient.   

We make this clear on the clinical portal so that it is visible to both primary and secondary care and this includes any changes during the patient’s admission whilst on caseload. Similarly at discharge we will update if there have been any changes or recommendations. 


Glasgow City 

  • Medication pathway established with prescribing, controls and supply. 
  • Risk managed through clinical portal. 
  • Relationship with community pharmacy. 
  • It is key to ensure that the team manage medications.
     

Fife 

Follow the medicines reconciliation process.  

Forth Valley  

We are using HEPMA to e-prescribe. To produce scripts staff use hospital based prescription pads. 

Moray  

We link with GPs for this. We routinely review patients’ medications. 

Lanarkshire

We use blue prescriptions pads for new medication. Liaising with community pharmacies, emailing change forms. 

Perth and Kinross 

GPs prescribe all new medication as per Vision requestsA more streamlined process is being developed to support prescribing within the service and not place a burden on Primary Care colleagues. 

Lothian 

We document changes in medications on TRAK. This is done in the medications box under the ‘ward round’ tab. We keep a list of active medications and then details of any changes made.  

For medications being issued by staff, these are prescribed on a hospital Kardex, hospital prescription pads or community prescription pads. We liaise closely with local pharmacies especially around dosettes.   


Western Isles

Have a Standard Operating Procedure (SOP) for both the standard 08:00-16:30 service and for the out of hours service. 

 

How is medicines reconciliation managed?

Aberdeen City 

Med rec form
 

Dundee City 

Information gathering prior to visit: drugs are noted from the Emergency Care Summary (ECS) on the clinical portal which is documented in the admission document. We then attend the patient at home and confirm with the patient and their medication. We review their repeat prescription list or if need be contact the locality pharmacist/GP or family/carers if there are any concerns. 

Glasgow City 

Assessed with pharmacist and decided through MDT. 

Fife 

Medicines reconciliation is carried out when a patient is admitted to H@H. Discharge letters, GP information etc. are checked and any issues checked with pharmacy. The Kardex is updated when and medicine changes happen. The team ask for pharmacy input if they have any concerns about the number of medications a patient is taking. 

Forth Valley 

On the first visit from an ANP or doctor, a medication reconciliation is one of first things carried out. The clinician will use two sources and go through patient’s drugs comparing with either their ECS or most up to date discharge letter. This is embedded in first clinical visit. 

We are hoping to incorporate polypharmacy reviews into the role. 

Moray

This is part of the routine reviews in geriatric assessments. 

Lanarkshire 

We do a medicines reconciliation on day of admission and a polypharmacy review on the ward round for every patient.  

Perth and Kinross 

  • Community pharmacy technician manages this. 
  • Team is able to assess compliance and access advice accordingly. 
  • Also part of clinical assessment on admission to H@H service.
     

Lothian 

This is done on admission and discharge. Patients’ medications are compared with the ECS, GP referral letter (SCI Gateway) and our own medication list. Final medications lists are communicated to the GP on the discharge letter. Any changes to dosette box medications are communicated to the dispensing pharmacy as a priority.   

Final medications lists are communicated to the GP on the discharge letter.  

Medicine reconciliation is noted to be an area of risk with ongoing monitoring and audit work.