Involving community pharmacists and pharmacists working in primary care networks (PCNs) in virtual wards has improved the quality of care for patients, a recent report by the Care Quality Commission (CQC) has found.

And it suggested that local late-night community pharmacies could fulfil prescription needs where possible.

The CQC also highlighted concerns about staffing and medicines governance when pharmacy teams were not involved in setting up virtual wards from the outset.

This comes as the Royal Pharmaceutical Society (RPS) released guidance around the role of pharmacy teams in virtual wards.

CQC highlights primary care pharmacists providing virtual ward solutions

Virtual wards, also known as hospital at home, deliver hospital-level care to patients in their own home or in care homes, facilitated through home visits and/or the use of technology.

But while the majority of patients admitted to virtual wards take medicines, the CQC identified that pharmacy teams were often not involved in setting up virtual wards from the outset, and that there was sometimes not an allocated budget for pharmacy staffing.

This meant that NHS trust chief pharmacists were often responsible for pharmacy leadership with no additional resource, ‘resulting in policy, practice, and governance of medicines being overlooked’, the CQC said.

It noted concerns around medicines guidance and formularies used by virtual wards, as well as around antimicrobial stewardship and medicines for end of life care.

And it highlighted how one virtual ward provider was using existing PCN and community pharmacy staff to support the virtual ward, which the CQC said ‘improved continuity of care’.

The CQC also identified challenges around storing medicines securely, ‘being clear around the accountability of medicines stored in people’s own homes’ and transporting medicines to people’s homes.

The report highlighted how one trust had identified community pharmacies with late opening hours that could receive late night prescription requests where necessary, although it said this did not solve the issue when people need medicines that could only be provided by the hospital.

Clinicians have warned The Pharmacist that a lack of joined-up planning around the reduced hours for 100-hour pharmacies that were introduced this summer could impact medicines supply to out-of-hours care.

RPS recommends flexible roles and prescribing for virtual wards

The CQC report follows the publication of interim professional standards published by the RPS ‘to assure high quality care, equity of care and best outcomes’ for virtual wards patients, in relation to both pharmacy services and medicines use.

The RPS confirmed that virtual ward care could be provided by acute, community and primary care sectors including community pharmacy teams, ‘with the overall accountability for clinical governance being with the nominated lead provider and led by a named senior healthcare professional’.

The standards recommend that:

  1. Patients and their carers should be involved in decisions about their care, and have access to information and the opportunity to ask questions about medicines.
  2. Medicines should be reconciled to optimise treatment, and any changes communicated clearly between providers, patients and carers to avoid disrupting usual medicines supply or oversupply. And patients and their carers should be asked for feedback on their experience of their medicines-related care, including prescribing, supply and support, in order to improve the service.
  3. Any medicines changed during admission and discharge should be communicated clearly between providers, patients and carers, with a discharge summary supplied by the virtual ward team.
  4. A medicines risk assessment should be undertaken when setting up the service, and reviewed regularly, prescribing pharmacists should expand their skills with the RPS’ Competency Framework for all Prescribers, medicines related incident reporting should be encouraged and learning should be shared with providers, patients and carers, standard operating procedures (SOPs) should be in place and developed with partners across the system, and pharmacy professionals working in virtual wards should be trained in recognising early deterioration of symptoms and how to escalate appropriately.
  5. Medicine supply must follow legal and regulatory framework, and preferably be conducted through prescribing for individual patients rather than patient group directions (PGDs). And patients and carers should be signposted on how to obtain medicines when needed, in and out of hours. Health, social and voluntary care should collaborate to transport medicines to the patient, where necessary, and there should be policies in place to ensure medicines are handled and stored appropriately.
  6. A senior pharmacy lead must be assigned to the virtual ward service at the outset of service development, ‘to design, implement, maintain pharmacy services, and coordinate all system pharmacy service providers across the different sectors including acute, community providers and primary care, including community pharmacy’. And they should lead on ‘quality improvement, management and clinical supervision’.
  7. Systems should be in place to enable research audit and quality improvement projects, and remote monitoring of patients. Digital solutions should also be used, with consent, to optimise patient care in diagnostics, monitoring, prescribing and communication. Finances should be planned, assessed and evaluated regularly and medicines should be managed effectively with a focus on addressing health inequalities, deprescribing and antimicrobial stewardship.
  8. Virtual wards teams should include ‘a trained pharmacy team with appropriate levels of staff available to deliver a safe and high-quality service by utilising the skill-mix of pharmacy team members, supervised by a senior pharmacy lead’. Pharmacy professionals should participate in board rounds, multidisciplinary team meetings and patient reviews. And workforce approaches such as rotational roles, flexible working and joint roles between primary and secondary care should be considered. Pharmacists should be trained as prescribers, and patients, carers and other healthcare professionals should be trained in how to handle medicines in a virtual ward setting.