PATIENT SAFETY
team to educate patients on important steps to improve and maintain their health.
A reduction in medication errors: Pre-automation 48 prescriptions included errors, during the course of the study the number of errors recorded were just seven and this was a result of human error post dispensing by the machine – further staff training has now helped to reduce this further still.
Developing the commercial potential of the Trust: The study and process validation has enabled the Trust to approach neighbouring Acute Trusts to offer a safe and reliable dispensing system for their patients’ medication adherence packs. This will provide the Trust with a new revenue stream as well as saving the Acute Trusts money, as they will no longer have to outsource from external organisations.
Access to the cabinets is managed by secure fingerprint recognition and this, along with a lockable drawer system, is said to guarantee that the security of controlled drugs is maximised. Both factors are of paramount importance for any mental health setting. Since introducing the cabinets, the hospital has seen an 11.7% reduction in drug spend based on a 16-month comparison. This is a financial saving of £6k per ward per year. There is now a more efficient medication supply chain in place across the wards, which has led to a further reduction in waste and loss of expired medication. Pharmacy stock wastage has reduced from 1% to 0%, which is a further £6000 saving per year. In addition to this, nurses have also reduced the time they spend on medicines management by 50%. Nurses now spend more time on face to face patient care which brings its own patient safety benefits. The cabinets have contributed to a 64% reduction in reports relating to controlled drugs. This is said to be due to the security the cabinet provides and the support
available for nurses managing stock balances. The number of ad-hoc/unplanned orders has fallen from 77% to 25%, as the medication supply chain is more pro-active and medication is now available to ward staff when it is needed – in fact 99.75% of medication is available for administration when and where needed. Workload is now planned and ordering automated. This has resulted in reliable inventory management. Maule asserted: “Since introducing automation at the Trust, there has been a 71% increase in pharmacy clinical interventions, as clinical pharmacy staff have been freed up from the medicines supply chain and are now more involved in patient facing roles, where they are better placed to make timely interventions to improve quality of care. “The Trust has had really positive experiences with technology and automation and now has valuable and skilled staff doing the most appropriate tasks and having the greatest impact on patient safety and experience.”
Safeguarding against medication errors
Over three quarters (79%) of medication errors within secondary care4
happen during
the administration process – so it’s vital that Trusts put systems in place to safeguard against this.
Errors are exacerbated by the increasing volume of work, staff shortages and the sheer rising number of patients accessing health services. So, if we are going to accept that this situation is not going to change in the near future, then we need to offer support for valued and indispensable frontline staff. Introducing electronic prescribing and medicines administration (ePMA) systems in hospitals has the potential to halve the risk of medication errors. However, in November 2017, just 35% of acute Trusts (where more than 80% of inpatients’ prescriptions are written digitally), and less
than 12% of mental health organisations had introduced the necessary systems.5 When using ePMA systems as a standalone process, patient safety is improved to a certain degree, however it doesn’t protect against the nurse picking the wrong drug, the wrong dose, out of date stock from the drugs cupboard or administering medication to the wrong patient. To help eradicate medication errors, a system to ‘close the loop’ is also needed. This includes automated dispensing, electronic confirmation of patient identity and medication administration records. This approach to administering medication allows Trusts to track everything back to the patient from the moment the medication is prescribed to when it is administered. In my opinion, there really is no excuse for poor medicines management within the NHS and our aim at Omnicell is to campaign and continue to share best practice and learning through medication-based automation. This includes demonstrating the efficiencies that ward based technology can provide to healthcare professionals managing medication and ensuring quality care remains at the forefront of our NHS. CSJ
References
1 Prevalence & Economic Burden of Medication Errors in the NHS in England. Policy and Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield & York.
2 WHO Global Patient Safety Challenge: Medication Without Harm.
https://www.who.int/patientsafety/policies/ global-launch-medication-without-harm-Bonn/en/
3 Data by Northumberland Tyne and Wear NHS Foundation Trust
4
http://www.eepru.org.uk/wp- content/uploads/2018/02/eepru-report- medicaiotn-error-feb-2018.pdf
5 The Report of the Short Life Working Group on reducing medication-related harm. Dept of Health and Social Care (Feb 2018).
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