Powys Clinical Pharmacist Rafael Baptista, whose work to develop and implement the xPIRT Pharmacy Intervention Recording Tool has won a UK-wide Community Hospitals Association Innovation and Best Practice Award.
Clinical and pharmaceutical interventions made by pharmacy professionals can have significant impact in ensuring optimised patient care and safety around medicines. Interventions include rationalising prescriptions and reducing/preventing medication errors by ensuring appropriate therapeutic choices.
Recording pharmacy interventions (PIs) yields essential data to inform the clinical and economic impact of pharmacy teams, allowing learning to be shared with other professionals, improving prescribing practice, building resource/capacity planning and ensuring appropriate skill mix of staff.
In 2021, the community hospital wards at Powys Teaching Health Board recorded 158 interventions, corresponding to a recording rate of 0.4 interventions per pharmacy staff per week. These figures were not a true representation of the work of a pharmacy professional in community hospitals. Low recording numbers can result in defective medication optimisation and prescribing rationalisation, increased costs and unidentified education and training opportunities.
Thus, an improvement project involving all PTHB community hospitals aimed to increase the number of PIs recorded in 2022 by 3-fold, and to analyse their clinical impact through the application of different methods of managing change in healthcare.
In 2022, PTHB have recorded 977 interventions in community hospitals, an increase of more than 600% compared to that of 2021, further expanding in 2023 to capture interventions performed in care homes. The most successful intervention that encouraged staff to report PIs was the implementation of a new Microsoft-based Pharmacy Intervention Record Tool (xPIRT) Toolkit. This included an online recording tool (xPIRT) and an interactive dashboard (xPIRT Dashboard) with live results from all interventions.
Motivating change was proven to be one of the best determinants to meet the project targets, as the xPIRT Dashboard provided staff and team managers with a visual repository that can be used for personal and shared learning around prescribing, therapeutics and pharmaceutical care. The xPIRT Dashboard provides real-time detailed interactive infographics on data analytics based on the PIs recorded: date, hospital, ward, contributor, drug, severity, type and sub-type, timeline, cost-avoidance, incident reports and Yellow Cards.
This digital health tool has prompted the production of four new clinical guidelines, medicines formulary changes and generated more awareness for prescribers not only for key issues around medicines optimisation and safety, but also for the value of the pharmacy teams in this healthcare setting.
This toolkit can be easily applied and adapted to other health organisations, settings or services, as it only uses Microsoft Office 365 applications. To demonstrate this to potential users, the development of xPIRT has been published in an open access article:
Using xPIRT to Record Pharmacy Interventions: An Observational, Cross-Sectional and Retrospective Study (Healthcare, 2022) https://www.mdpi.com/2227 9032/10/12/2450
The work of Rafael and colleagues to develop and implement the system was recognised by the Community Hospitals Association through their Innovation and Best Practice Awards on 3 July 2023: http://communityhospitals.org.uk/quality-improvement/innovation-best-practice.html