The Pharmaceutical Journal
Vol 269 No 7218 p496
5 October 2002

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British Pharmaceutical Conference 2002 summary

A charter for hospital pharmacy

The Audit Commission's report "A spoonful of sugar" should be seen as a pharmacist's charter, according to NICK MAPSTONE, senior manager at the commission. "If it is, it is because pharmacy should be taken seriously," he said.

Mr Mapstone headed his session "Taking a spoonful of sugar: responding to key issues from the Audit Commission report". He said that much of what is in the report is about medicines management in National Health Service hospitals. It had been important to report on medicines management because a lot of the medicines budget is not adequately funded. Clinical governance and risk management also play a part in medicines management, and so looking at pharmacy services was a valuable exercise. Electronic patient records will also contribute to good medicines management and information technology departments are using "A spoonful of sugar" as ammunition to prepare their case to implement it.

"At the end of all this we have the patients. The media are full of reports of patients dying because of doctors and drugs. The rates of errors are significant and if we are concerned with this, we should also be concerned with clinical governance," said Mr Mapstone.

He asked why it is so difficult to get it right but realised that the problem is not one for the NHS alone. He said that it is an international problem. "In Norway, 20 per cent of hospital deaths are because of the effects of medicines. In the United States, 3.7 per cent of hospital admissions are because of adverse drug events, with 98,000 deaths each year attributable to medical error. This amounts to one adverse drug event every 41 seconds and one death every 75 minutes."

He emphasised that the status quo is not an option. In the United Kingdom, 10.8 per cent of patients have an adverse event, each one leading to an average extra 8.5 days stay in hospital. Each year, £500m is spent treating iatrogenic disease. A typical hospital has five beds occupied by patients made more ill by errors. These statistics are good evidence to show that pharmacists can make a business case to be involved in medicines management and help in the process of tackling errors.

Electronic prescribing

Mr Mapstone thinks that the solution to drug errors is self-evident. "Electronic prescribing could eliminate 75 per cent of errors, process redesign and automation could reduce errors from 10 per cent to 2.5 per cent. Proactive care by pharmacists, patient pack dispensing, self-administration of drugs by patients and patients' own drugs would also help in preventing medicine errors. However, delivery is difficult."

In conclusion, Mr Mapstone said, 'A spoonful of sugar' has made the greatest progress in the shortest time. It has provided the bullets for pharmacists to fire."

The MCA view

JAN MACDONALD, specialist in product information, Medicines Control Agency, echoed much of what was covered in Mr Mapstone's presentation. She began by reminding the audience of the findings of the Chief Medical Officer for England's report "An organisation with a memory" published in May 2000. This document looked at what could be learnt from adverse events in the NHS since, at that time, 10,000 patients a year suffered an adverse drug event, and medicine errors accounted for 20 per cent of the litigation against the NHS. A target was set to reduce serious medical errors by 40 per cent by 2005.

"Building a safer NHS for patients" was published in 2001 to implement "An organisation with a memory". This suggests that 25 per cent of drug errors are a result of poor labelling. "It is only part of the problem but it is significant," said Mrs MacDonald. She went on to say that the Committee on Safety of Medicines and the Medicines Control Agency have established a working group to review medicines labelling and packaging, which should be reporting to ministers within three months. The group has undertaken a literature review and looked at how other countries tackle the problem. They have found that there is no substitute for reading the label, certain items of information are critical for safe use, the presentation of information is important, and mistakes happen because of similarities in packaging of look-a-like and sound-a-like drug names.

Mrs MacDonald described in detail the proposals for labels in general, those for small containers and those for blister packs. These are to be published in late autumn in a best practice document which has been developed in co-operation with the Association of the British Pharmaceutical Industry, the British Generic Manufacturers Association, the Proprietary Association of Great Britain, the CSM and lay members.

"Good labelling will be one strand to reduce medical errors by 40 per cent by 2005," she concluded.

NICE money

After giving a broad overview of how NHS money has been spent in the past 30 years, GRAHAM URWIN, director of finance, South Birmingham Primary Care Trust, turned his thoughts to the affordability of National Institute for Clinical Excellence guidelines and the implications for hospitals, with particular reference to Alzheimer's disease.

"NICE gives rulings on new drugs and technologies, but who then makes the decision on whether or not to supply the drugs?" asked Mr Urwin. "When new drugs are approved, we have no idea of how much they are going to cost without a sound business case being made."

He said that both accountants and pharmacists might be involved in the process, but neither group manages hospital and community drug budgets. They can give advice but unless they have a passion for the organisation they will not succeed, according to Mr Urwin.

He then talked about the introduction of donepezil (Aricept) for Alzheimer's disease. He said that before NICE, one of the consultants in his area wanted to prescribe it as soon as it was available. At this time, Birmingham was conducting a trial into its use and the consultant was told that if he wanted to prescribe it he had to subscribe to the trial. The consultant did not want to and prescribed donepezil anyway as there were few controls in place to stop him.

Memory clinics have now been put in place in Birmingham, with multidisciplinary teams including pharmacists. The PCT has found that as a result the cost of donepezil per patient per year is 10 per cent lower if there is a pharmacist in the team than if there is no pharmacist in the team.
— Contributed by Diane Langleben, editor, Hospital Pharmacist.