TRAINING & EDUCATION
applied to help reduce prescription errors especially when these caused by inaccuracies resulting from staff shortages and lack of time. Automation in the pharmacy and the ward can also prove instrumental at the dispensing stage, helping staff locate the right drug, in the right dosage at the right time, promoting greater safety, but also general efficiency.
Automation
At the administration stage increased automation of processes can also play a critical role, helping reduce dose error reduction via closed-loop solutions combining an updated and extensive drug library, infusion analytics, enterprise management software and patient-centred clinical services. Finally, at the preparation phase, standardising workflow through an integrated, fully traceable gravimetric solution helps not only avoid error, but perform more accurate audits.
The human element
While there are some specific processes that require particular attention the over-arching requirement is that of establishing a culture of patient safety. Specifically, although automation and e-prescriptions are an option to hospitals, they cannot alone curb the issue sufficiently without work to change processes and culture simultaneously being undertaken in the NHS.
The entire medication management process needs to be optimised and, while technology will play a critical role, the way this technology is implemented and used throughout the hospital setting is what will make the biggest impact on patient safety. Training, but also informal activities such as ward-walks and interviews with nursing and pharmacy staff, play a critical role in supporting hospitals to manage risk alongside the implementation of automation and technology. Flexibility is another core requirement; having assessed the human element and introduced automation, it is vital that the technology is not rigid and difficult to use,
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but that a flexible system of information sharing is set up to flow between platforms and clinical information systems. A truly customisable solution should allow a hospital or Trust to integrate basic parameters or complex compounding and dispensing workflows with ease. Advocates of automation in dispensing of medication highlight how this releases time for care for nurses and pharmacists, enabling them to focus on patients rather than just the processes of dispensing medicine. The implementation of a holistic patient safety culture and automation also critically enables the achievement of ‘The Five Rights of Medication Administration’ as set out by the Institute of Healthcare Improvement, which recommends that to reduce medication error and harm it is necessary to keep in mind the following: the right drug administered to the right patient, at the right dose, via the right route and at the right time.14 Another critical element is the promotion of unique identifier barcodes to ensure that the right drug reaches the right patient. Barcoding is useful far beyond simply the pharmacy setting, and enables tracking and efficiency from dispensing right through to the patient’s bedside, such as when
barcoding is also present on a wristband worn by the patient, for example.
Conclusion
All these solutions, however, clearly need to be bound together by a commitment to encourage more transparent medication management that is efficient and empowering. On-going change management that combines new technical implementations and advances is a key feature of all the successful examples BD has seen over the years, where hospitals and Trusts have decided to tackle the issue of medication error by understanding which processes were lacking and how their staff could be enabled to work better, more safely and more efficiently. One key example is the STS AG Hospital
in Thun, Switzerland, which recently became the first hospital in the world to introduce a fully automated hospital-wide prescription medicines supply chain, for better delivery of patients’ medicines from the central pharmacy to the ward or care unit, improving patient safety. Traditionally, medication dispensing cabinets are manually filled and replenished with drugs by the hospital pharmacy. The new solution provides secure storage of drugs on the ward and facilitates improved patient safety and efficiency in medication dispensing. Individual drugs are stored in separate drawers and pockets to avoid confusion, and if stock is low the system automatically sends a replenishment order to the hospital pharmacy.
In addition to this, ward staff can call up the drugs prescribed by the doctor directly on screens in the ward, ensuring the right drug is going to the right patient, in the right dose, at the right time. Ad hoc interfaces were developed especially to enable this direct flow of communication between pharmacy and ward.
It’s clear that engaging in innovation
isn’t just about purchasing new technology. It also means understanding the potential benefits it can bring when combined with training and engaging staff, so they are
JUNE 2018
©Katarzyna Bialasiewicz
photographee.eu
©Artem Varnitsin - Fotolia
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