MEDICATION ERRORS
Ewan observed that the automated medication dispensing cabinets implemented on the wards ensure that the right patient receives the right dose of the right drug at the right time. “Access to the cabinets is managed by secure fingerprint recognition and this, along with a lockable drawer system, guarantees that the security of controlled drugs is maximised,” he noted. “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 £6k 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 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. Ewan observed: “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 have valuable and skilled staff doing the most appropriate tasks and having the greatest impact on patient safety and experience.”
Conclusion
It is unclear why the Department of Health set up its own review panel ahead of the reports and usually comprehensive evidence based recommendations by WHO. It is almost certainly to do with the cost of our drugs bill, which, in the NHS alone, is £17 billion, and said to be rising at 8% each year. In addition, it is said that £300 million is wasted annually on pharmaceuticals, although it is not clarified how or why. It is certain that there is a huge training and development agenda involved in this patient safety issue and many patients who could benefit from fewer errors.
Multidisciplinary simulation and prescriber training would be of great benefit and should embrace primary, secondary and care home settings. It will be interesting to learn what the WHO recommends to reduce the harm globally.
References
1 WHO Third global patient safety challenge: tackling medication-related harm. Bulletin of WHO 2017;95:546-546A Accessed at
www.who.int/ bulletin/volumes/95/8/17-198002/en
2 Elliott R, Camacho E, Campbell F, Jankovic D, Martyn St James M, Kaltenthaler E, Wong R, Sculpher M, Faria R, (2018). Prevalence and Economic Burden of Medication Errors in The NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK. Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York. Accessed at
http://www.eepru.org.uk/wp-content/uploads/2018/ 02/eepru-report-medication-error-feb-2018.pdf
3 Ibid 4 Williams DJP. Medication Errors. J R Coll. Physicians Edinb. 2007; 37:343–346.
http://www.rcpe.ac.uk/journal/issue/journal _37_4/Williams.pdf
5 Pirmohamed M., James S., Meakin S., Green C., Scott A. K., Walley T. J., Farrar K., Park B. K., and Breckenridge A. M. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 3- 7-2004; 329 (7456):15-19.
http://www.ncbi.nlm.nih.gov/pubmed/15231615
6 EQUIP study 2009. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education.
http://www.gmcuk.org/FINAL_Report_prevalence_
26 I
WWW.CLINICALSERVICESJOURNAL.COM
and_causes_of_prescribing_errors.pdf_ 28935150.pdf
7 Mahajan RP British J of Anaesthesia, Vol 107, Issue 1, 1 July 2011 pages 3-5.
https://academic.oup.com/ja/article/107/1/3/330876
CSJ
8 Ibid 9 A PINCH The Clinical Excellence Commission 2017 Accessed at
http://www.cec.health.nsw.gov.au/ patient-safety-programs/medication-safety/ high-risk-medicines/A-PINCH
10 Department of Health, London. The Report of the Short Life Working Group on reducing medication- related harm. February 2018. Accessed at
https://www.gov.uk/government/publications/ medication-errors-short-life-working-group-report
11 NHS England Medicines Value Programme. Accessed at
https://www.england.nhs.uk/ medicines/value-programme/
12 Patient safety Solutions 2007 Look Alike, Sound Alike Medications. Accessed at
http://www.who.int/patientsafety/solutions/ patientsafety/PS-Solution1.pdf?ua=1
13. World Health Organization. WHO Global Patient Safety Challenge: Medication Without Harm. Available at:
http://www.who.int/ patientsafety/medication-safety/medication- without-harm-brochure/en/ Last accessed 25.04.2018
14.
http://www.eepru.org.uk/wp-content/uploads/ 2018/02/eepru-report-medication-error-feb- 2018.pdf
15. As authored by Fawz Farhan 16.
http://www.eepru.org.uk/wp-content/uploads/2018/ 02/eepru-report-medication-error-feb-2018.pdf
17. The Report of the Short Life Working Group on reducing medication-related harm. Department of Health and Social Care. February 2018.
18. Data by Northumberland Tyne and Wear NHS Foundation Trust
JUNE 2018
© 2017 Kristen Prahl
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