Objectives The role of clinical pharmacists in hospitals has evolved and continues to expand. In the UK, outside of a few national policy drivers, there are no agreed priorities, measures or defined outcomes for hospital clinical pharmacy (CP). This paper aims to (1) highlight the need to identify and prioritise specific CP roles, responsibilities and practices that will bring the greatest benefit to patients and health systems and (2) describe systematic weaknesses in current research methodologies for evaluating CP services and propose a different approach. Method Published reviews of CP services are discussed using the Economic, Clinical and Humanistic Outcomes framework. Recurring themes regarding study methodologies, measurements and outcomes are used to highlight current weaknesses in studies evaluating CP. Results Published studies aiming to demonstrate the economic, clinical or humanistic outcomes of CP often suffer from poor research design and inconsistencies in interventions, measurements and outcomes. This has caused difficulties in drawing meaningful conclusions regarding CP’s definitive contribution to patient outcomes. Conclusion There is a need for more research work in National Health Service (NHS) hospitals, employing a different paradigm to address some of the weaknesses of existing research on CP practice. We propose a mixed-methods approach, including qualitative research designs, and with emphasis on cost-consequence analyses for economic evaluations. This approach will provide more meaningful data to inform policy and demonstrate the contribution of hospital CP activities to patient care and the NHS.

Background Errors in discharge prescriptions are problematic. When hospital pharmacists write discharge prescriptions improvements are seen in the quality and efficiency of discharge. There is limited information on the incidence of errors in pharmacists’ medication orders. Objective To investigate the extent and clinical significance of errors in pharmacist-written discharge medication orders. Setting 1000-bed teaching hospital in London, UK. Method Pharmacists in this London hospital routinely write discharge medication orders as part of the clinical pharmacy service. Convenient days, based on researcher availability, between October 2013 and January 2014 were selected. Pre-registration pharmacists reviewed all discharge medication orders written by pharmacists on these days and identified discrepancies between the medication history, inpatient chart, patient records and discharge summary. A senior clinical pharmacist confirmed the presence of an error. Each error was assigned a potential clinical significance rating (based on the NCCMERP scale) by a physician and an independent senior clinical pharmacist, working separately. Main outcome measure Incidence of errors in pharmacist-written discharge medication orders. Results 509 prescriptions, written by 51 pharmacists, containing 4258 discharge medication orders were assessed (8.4 orders per prescription). Ten prescriptions (2%), contained a total of ten erroneous orders (order error rate—0.2%). The pharmacist considered that one error had the potential to cause temporary harm (0.02% of all orders). The physician did not rate any of the errors with the potential to cause harm. Conclusion The incidence of errors in pharmacists’ discharge medication orders was low. The quality, safety and policy implications of pharmacists routinely writing discharge medication orders should be further explored.

Objective To describe the cost–benefits of pharmacy-led medicines reconciliation (MR) on admission by applying a theoretical model (University of Sheffield School of Health and Related Research—SCHARR model) to real-world data. Methods This was a retrospective, single-centre study. Setting 1000-bedded teaching hospital in London, UK. Clinical pharmacy contributions related to unintended medication discrepancies (averted preventable adverse drug events, pADEs), documented by pharmacy staff on prearranged days during 2012, were assessed for clinical significance by a panel of senior clinical pharmacists using the SCHARR model. Costs avoided were allocated according to the SCHARR model. Pharmacy staff carrying out admission MR were timed. Net cost avoidance was calculated by subtracting cost of time taken to carry out MR from the costs avoided by averting pADEs. Sensitivity analyses were carried out. Results 118 pADEs averted as a result of MR were recorded over the 6 reporting days. 116 were rated for clinical significance. Gross costs avoided were £36 135–£75 249 (€44 446–€92 556). The admission MR process was timed for 48 patients. The mean time to complete MR for one patient was 14 min (range 1–40 min). The cost of carrying out one MR, based on the cost of employing a first-level post-foundation clinical pharmacist was £7.56 (€9.30). The net benefit of one MR was £34–£80 (€42–€98). The benefit:cost ratio was 5.53:1–11.51:1. Conclusions Pharmacy-led MR on admission has significant economic, as well as clinical benefits. Further work is required for full economic evaluations of MR.

Introduction: It is widely acknowledged that health disparities exist in minority populations, with ethnicity, gender, language, ability and culture emerging as critical determinants of health outcomes. At present, research is available demonstrating that patients with protected characteristics experience less favourable patient safety outcomes. However, there has been limited focus on reviewing how processes within the healthcare system contribute to this inequity of care received by minority populations. This study reviews the prevalence of incident reporting of medication errors for people with selected protected patient characteristics within an acute NHS Trust. The aim is to determine if there are unexplained variations. Method: This cross-sectional study was conducted across an NHS Trust group of five hospitals, serving a diverse local population. Incidents reporting errors in medication use were obtained for the 7-month period between 1 January 2021 and 31 July 2021. The χ² test was used to assess if protected patient characteristics impacted the rate of medicine-related error reporting. Result: Medication error reporting is not equitable between different gender, ethnic or age groups. The results of this study show that these characteristics were negatively related to the number of medication incidents reported. Conclusion: This study demonstrates that further systematic support is required to reduce the variations in medicine error reporting for patients with key protected characteristics. Infrastructure to overcome known barriers to safe care in the mainstream such as language, culture, beliefs and lower levels of understanding needs further development.