The Pharmaceutical Journal
Vol 268 No 7183 p137-140
2 February 2002

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Letters to the Editor

Hospital Pharmacy (2 letters)

Stop wasting money on identifying problems

From Mr R. M. Hall, MRPharmS

It was a disappointment to read in The Pharmaceutical Journal (26 January, p82) that money is still being spent on research to show that discharge information needs to be improved to prevent prescribing errors. This has been a contentious issue throughout my 40-plus years as a pharmacist, with innumerable studies having been published on the subject.

We must know by now what the causes of the problem are, so why not spend the money wasted on continually identifying the problem on actually solving it?

Some areas have made the effort to overcome the difficulties involved. For example, I believe the Secretary of the Royal Pharmaceutical Society (Ann Lewis) was instrumental in implementing successful procedures when she was a hospital pharmacist. Why cannot this, or similar examples of best practice, be made universal throughout the National Health Service to the benefit of patients and, indeed, the health service itself.

Richard Hall
Market Drayton, Shropshire

Reusing patients' own drugs at Addenbrooke's

From Ms H. St C. Remington, MRPharmS, and Ms S. Gray

We were interested to read the paper "An investigation into the clinical risks in the use of patients' own drugs on surgical wards".1 The procedures to manage the risks of reuse of PODs in Addenbrooke's NHS Trust on all types of wards have shown that there are opportunities to improve pharmaceutical management of patients, too.

We have established criteria for reuse, and developed standard operating procedures for all aspects of the process, including relabelling. Reuse fits within an overall strategy of medicines management to achieve the most efficient and cost-effective supply chain. This embraces medication histories, reuse of PODs, dispensing 28-day quantities for discharge where necessary, self-administration and pharmacist prescribing. All parts of this whole approach are not yet operational trust-wide, but they are developing and spreading throughout the hospital as staffing permits.

A risk assessment approach is used to identify the level of pharmacy support necessary.

Trials of nurse POD assessment for routine, as opposed to exceptional use (commonplace in most trusts), found that nurses did not detect the discrepancies in PODs against inpatient treatment chart prescribing that pharmacy technicians identified. Nurses were also unable to identify medicines safely. Involvement of nurses was not judged appropriate in contexts where the trust was accepting liability and the task was complex, ie, in medicine and surgery generally. However in maternity wards, where the range of drugs is narrower, and in community trust beds, where GPs continue care with chronic established therapy, nurses are conducting the POD reviews. Pharmacy has undertaken to train these nurses according to our established criteria.

In all cases where nurses authorise incoming PODs for exceptional reuse (ie, to address out-of-hours need or non-formulary selection) they follow trust procedures. This requires that certain high-risk drugs and their prescription have separate accreditation, eg, methotrexate, all chemotherapy and warfarin.

The benefits of the involvement of technicians have been demonstrated in identification of unintended change or omission of medication by junior doctors on patient admission. A full record of PODs is completed either by nurses, as part of the "valuables" clerking procedure using a dedicated POD assessment form (and then this is checked by the pharmacy technician), or by the pharmacy technician because the nurse did not perform the task. This record is kept with the inpatient treatment sheet. The pharmacist is responsible for managing any discrepancy and then communicating the outcome briefly on the form. This record assists with discharge medication management, too.

All our procedures for medicines management are available through the NHSnet at nww.addenbrookes-pharmacy.nhs.uk.

The latest procedure, "Planned reuse of PODs" will join these after trust executive board approval which is due in March.

Helen Remington
Chief Pharmacist

Sarah Gray
Principal Technician — Clinical Services
Addenbrooke's NHS Trust,
Cambridge

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