MEDICATION & RESEARCH
people at every stage of the process, supported by inadequate storage facilities that by now are not fit for purpose. To manage this current process, hospitals introduce their own mandatory strategy and policy underpinned by a set of risk- assessed standard operating procedures (SOPs). These SOPs are introduced to cover the training of pharmacy professionals and nurses, storage of CDs, the ordering and supply, prescribing, recording (via a ledger/paper record book), as well as the transportation and destruction and disposal of CDs. The SOPs are complex and fraught with the risk of error, from the need to find authorised staff on a busy ward to record newly arrived stock in a record book, to requirements to find an appropriate witnesses for counter-recording data. Variations across hospitals is widespread.
As such, the detailed, consistent record keeping of issues and problems with associated outcomes of incidents nationwide is also sparse and oſten anecdotal. Comprehensive data linked to incidents reported to NHS England is subject to variation, making it almost impossible to gain a complete overall and accurate national picture. According to data from 2018/9, the number of incidents reported to NHS England and published by the CQC for the first time included 2,899 unaccounted losses of CDs, with nearly half of these being either lost, stolen or missing. Due to the staggered rollout of a new reporting tool and the interpretation of risk by individual organisations, there was an average of eight daily unaccounted for losses recorded in England alone. No-one believes this is an informative or accurate reflection on what is happening at a grass root level.
The report went on to recommend the optimal way to order, store and manage controlled drugs using a closed loop digital system. A greater use of technological systems and automated drug cabinets will improve the audit trail and create a consistency in processes. While this programme has, without doubt, started to become truly widespread, it requires a greater degree of support in reference sources — such as a ‘Medicines, Ethics & Practice Guide’ is called for to drive real progress.
local and national systems for reporting CD incidents should be used in organisations and CDAW must be kept informed – especially true during the changeover from paper, lock and key based systems.
The clear set of recommendations are set out in the report include the following:
1. New technologies, including automated dispensing systems should be included within a legal framework for handling controlled drugs.
2. Ordering, storing, dispensing and administering CDs in hospitals should be through automated dispensing systems.
3. The need for a ‘wet’ signature from a prescriber on electronic patient discharge and outpatient prescriptions should be reviewed.
4. The paperless CD record book should be replaced with electronic registers.
5. A digital system to record the movement of the messenger transporting CDs from pharmacy to a clinical area should be used.
6. The ‘messenger’ to put the CDs into the automated dispensing system to verify stock quantity with authorised user in the clinical area.
7. A nationally recognised, consistent approach to automation and digitalisation in the handling of CDs, underpinned by a CD policy and standardised operating procedures (SOPs) needs to be introduced.
8. An inclusive training programme for the handling of CDs using automation and digitalisation should be provided to all HCPs.
https://www.omnicell.co.uk/UK/docs/FINAL%20An%20advisory%20document%20around%20the%20handling%20of%20Controlled%20Drugs%20final%20October%205%202021.pdf
A full copy of the advisory document can be found here.
www.omnicell.co.uk
Case study examples of the benefits of using automated systems for handling CDs
The benefits of automation and digitalisation were analysed within the advisory document. These included the fact that a digital recording system provides an audit trail showing who has handled what, when. A cabinet can secure stock from access to all but authorised HCPs (via fingerprint technology), with each CD supplied having a unique code associated with it. CD cabinets in clinical areas are linked to pharmacy cabinets creating a unique order process with a full paper trail. The digital system also allows for end-to-end tracking, ordering and restocking negating the need for a timely, arduous manual stock take. Finally, the automated system can connect to the ePMA and determine which drugs are needed for which patients on the ward.
There are currently a variety of automated systems available in the hospital setting – some in pharmacy, some on wards and in operating theatres. A few use an integrated system where the pharmacy and clinical settings are fully automated. The report calls on the Home Office to set a legal framework supported by the GPhC and the CQC. Agreeing governance arrangements for CDs with clear lines of responsibility and accountability should include harnessing technology to digitalise and automate processes. It is also believed that
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Leeds Teaching Hospitals NHS Trust was an early adopter of a pharmacy-based robot, an automated dispensing cabinet (ADC) and reported a reduction in time to dispense CDs of 50%.
Belfast Health and Social Care Trust: Prior to the installation of the cabinet there had been a 20% increase in CD activity from 2013 to 2018 affecting working conditions, causing staff anxieties and naturally an increase in medication errors due to volume pressures. Automation reduced the time taken to supply CDs by 63% and the error rate was reduced from 24 per 1000 to 9 per 1000.
University Hospital Coventry & Warwickshire: Following the introduction of automated medicines cabinets including AMCs for the pharmacy CD room, transaction time for CDs was reduced by an average of 1 minute 48 seconds. This equates to a time saving of over 15 hours per week for a pharmacy technician.
Chesterfield Royal Hospital: The audit of controlled drugs in the clinical area involved a daily stock count. With the implementation of automation, this activity was reported to take less than 50% of the time previously taken.
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