Pharmacy services at admission and discharge in adult, acute, public hospitals in Ireland Tamasine Grimes 1,2 , Catherine Duggan 3,4 and Tim Delaney 1 1 Pharmacy Department, Adelaide and Meath Hospital, incorporating the National Children’s Hospital (AMNCH), Tallaght, Dublin, Ireland, 2 School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland, 3 Department of Practice and Policy, School of Pharmacy, University of London, London, UK and 4 Clinical Pharmacy Development and Evaluation for East and South East England, NHS, London, UK Abstract Objectives To describe hospital pharmacy involvement in medication management in Ireland, both generally and at points of transfer of care, and to gain a broad perspective of the hospital pharmacy workforce. Methods A survey of all adult, acute, public hospitals with an accident and emergency (A&E) department (n = 36), using a semi-structured telephone interview. Key findings There was a 97% (n = 35) response rate. The majority (n = 25, 71.4%) of hospitals reported delivery of a clinical pharmacy service. On admission, pharmacists were involved in taking or verifying medication histories in a minority (n = 15, 42.9%) of hospi- tals, while few (n = 6, 17.1%) deployed staff to the A&E/acute medical admissions unit. On discharge, the majority (n = 30, 85.7%) did not supply any take-out medication, a minority (n = 5, 14.3%) checked the discharge prescription, 51.4% (n = 18) counselled patients, 42.9% (n = 15) provided medication compliance charts and one hospital (2.9%) communi- cated with the patient’s community pharmacy. The number of staff employed in the phar- macy department in each hospital was not proportionate to the number of inpatient beds, nor the volume of admissions from A&E. There were differences identified in service delivery between hospitals of different type: urban hospitals with a high volume of admissions from A&E were more likely to deliver clinical pharmacy. Conclusions The frequency and consistency of delivering pharmacy services to facilitate medication reconciliation at admission and discharge could be improved. Workforce con- straints may inhibit service expansion. Development of national standards of practice may help to eliminate variation between hospitals and support service development. Keywords clinical pharmacy; hospital pharmacy; medication management; medicines reconciliation; workforce planning Introduction Policy developments in the UK over the past decade have supported the planning, develop- ment and implementation of hospital pharmacy services. [1–5] In 2001, the Audit Commission reported that, where it is properly planned and supported, investment in clinical pharmacy improves the quality of patient care and decreases costs. [1] Medication reconciliation was defined by the Institute for Healthcare Improvement (IHI) in the USA as ‘the process of obtaining and maintaining an accurate and detailed list of all prescribed and non-prescribed drugs a patient is taking, including dosage and frequency, through all healthcare encounters and comparing the physician’s admission, transfer, and/or discharge orders to that list, recognising any discrepancies, and documenting any changes, thus resulting in a complete list of medications, accurately communicated’. [6] In 2007, the National Institute for Health and Clinical Excellence and the National Patient Safety Agency together recommended the implementation of medicines reconciliation on admission and the involvement of pharma- cists in the process at the earliest possible opportunity during hospital care. [5] In 2008, the National Prescribing Centre in the UK went further to recommend that medicines recon- ciliation be put in place at all ‘transfer of care’ situations. [7] In Australia, admission medi- cation history taking is regarded as part of a basic clinical pharmacy service recommended for every inpatient and the Society of Hospital Pharmacists in Australia (SHPA) have outlined professional practice standards for medication reconciliation. [8,9] In addition, they Research Paper IJPP 2010, 18: 346–352 © 2010 The Authors IJPP © 2010 Royal Pharmaceutical Society of Great Britain Received April 19, 2010 Accepted July 30, 2010 DOI 10.1111/j.2042-7174.2010.00064.x ISSN 0961-7671 Correspondence: Dr Tamasine Grimes, Pharmacy Department, Adelaide and Meath Hospital, incorporating the National Children’s Hospital (AMNCH), Tallaght, Dublin 24, Ireland. E-mail: tamasine.grimes@amnch.ie 346