Effective medicines management is vital to improving patient safety

 In Clinical Guidelines, Medicines Management Processes

Since the Care Quality Commission launched its ‘fundamental standards’ in April 2015, focus has increasingly shifted towards quality and safety, with a particular interest in the important issue of maintaining patient safety.

The safe and effective use of medicines forms an important part of making people well and maintaining their health.

However, studies by the National Patient Safety Agency have suggested that up to 9% of all patients staying in hospital experience medication-related harm. Many of these incidents would have been preventable by improving processes and training related to the management of medication.

Our own research suggests that there may still be some way to go to improve patient safety in hospitals. A recent survey carried out amongst 200 healthcare staff by Ashtons Hospital Pharmacy Services found that just 28% of healthcare staff are completely confident about patient safety in their hospital. Given the clear link between medicines management and patient safety, it is very concerning to learn that the survey also found that just 24% of healthcare staff are completely confident about the standards of medicines management in their hospital. But do they know how to improve?

In an effort to improve and maintain patient safety, hospitals need to take all possible steps to ensure medicines management is of a high standard. Effective medicines management is not just important for regulatory compliance but is essential to maintaining a positive experience for patients. This can be achieved by ensuring prescribing and administration of medicines is properly audited, that policies and procedures are effective, that medication audit trails are robust and that staff are well trained, especially in specialist areas such as the management of diabetes.

Our experience of working in partnership with healthcare providers of all sizes for over 25 years means that we have identified five key areas to help hospitals improve their medicines management, and as a consequence, patient safety.

Input from a specialist clinical pharmacist

One of the most effective methods of improving the quality of medicines management is to arrange for regular visits from a specialist clinical pharmacist. By carrying out a clinical review of prescription charts, auditing all aspects of medicines management, and providing advice and drug information, a clinical pharmacist can help a hospital’s clinical team to significantly reduce errors and improve patient care. By using audit standards to objectively measure performance and benchmarking against similar services, problem areas can be identified and addressed.

Medication audit trail

A focus on creating a robust medication audit trail throughout the hospital will not only help to keep medication secure but will also help to reduce medication errors by highlighting where and when they occur. This will help to identify any risky or negligent practices in relation to how and when patients are given their medication and the size of the doses they receive. A really effective way to achieve this is to use documentation systems to record every time a medicine is either received, administered, moved or disposed of. Electronic pharmacy reporting systems, such as Ashtons Live View, also help to reduce mistakes, with an average of an 18% reduction of errors among our hospital clients since July 2014.

Best practice policies and audits

Establishing an audit trail in this way goes hand-in-hand with ensuring that a hospital’s policies and procedures follow best practice guidelines and are compliant with the latest regulations, having been set up in a way that ensures a safe and effective outcome for the patient. This may include how the introduction of new medication is implemented, how to raise safety concerns or the process for managing treatment with a specialist drug, such as lithium, warfarin or clozapine.

Specialist training

However, these improvements will only make a real difference if all clinical and healthcare staff are suitably trained – not just by building a high-level understanding of medicines management, but also in the specific requirements of treating patients with specialist medicines or treatment regimes. This may include the use of Controlled Drugs, managing diabetes or carrying out rapid tranquillisation safely and effectively, all of which can require special monitoring.

In all circumstances, enhancing the skills of clinical and healthcare staff in the management of medicines will help to improve patient safety and help avoid tragic mistakes.

Supply of medication

A final area that should not be discounted is establishing a robust and reliable supply of medication, and ensuring stocks are managed effectively. The management of emergency drugs is particularly important. Due to their very nature, it is crucial that these medicines are available when they are needed. This makes it vital to ensure the contents of any hospital emergency drugs box are maintained properly and replenished promptly before they go out of date.

Getting things right

Medicines management is complex and often challenging, particularly in environments where specialist medicines and regimes are required. Our research suggests that in many hospitals there is still room for improvement in this area, but by putting robust measures in place, healthcare providers can dramatically reduce errors and, as a result, decrease the risk to their patients.

When things go wrong, it is essential that errors and incidents are analyzed and this should lead to steps being taken to prevent reoccurrence in order to make improvements to patient safety. So learning from mistakes is key to patient safety.

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