Pharmacists have role in patient safety, says NPSA
Claire Paxton and Jacqui Farrow/SPL
Intravenous drug infusions are high risk |
How pharmacists can help to improve patient safety is addressed in consultation documents released last week by the National Patient Safety Agency (NPSA).
The consultations will form the basis for four patient safety alerts
to be issued in the second quarter of the year, focusing on anticoagulant
therapy, wrong route administration errors, preparation and administration
of injectable medicines, and paediatric infusion safety.
The draft document on the safe use of anticoagulant therapy highlights
that not all workers involved with the prescribing and monitoring of
anticoagulants have received the necessary level of training. The proposal
suggests the employment of pharmacists and nurses — with specialist
training in a specified range of competencies — to prescribe and
adjust anticoagulant regimens.
Another area of concern is the potential for errors when inadequate safety
checks have been carried out during repeat prescribing and repeat dispensing
of anticoagulants in the community. Pharmacists will have a role in formalising
the required safety checks when anticoagulants are being dispensed for
patients, for example, ensuring that the international normalised ratio
(INR) is being monitored regularly and that the INR is within range at
the prescribed dose.
Several recommendations have been made in the draft document on preventing
wrong route errors. If implemented, the recommendations would require
that only oral syringes be used for measuring and administering oral
liquid medicines and enteral feeds and flushes. Trusts would also be
required to use enteral feeding tubes with safe ports that cannot connect
to intravenous syringes, and the removal of any adaptors that enable
oral syringes to connect to parenteral lines would be mandatory.
The NPSA has made proposals intended to improve the safe preparation
and administration of injectable products in “near patient areas”.
The recommendations include having a pharmacist and a senior practitioner
undertake a standardised assessment of the risks involved in preparing
and administering parenterals, as well as the risks presented by the
individual injectable product. The NPSA plans to introduce a multiprofessional
standard of practice for the preparation and administration of injectable
medicines.
Paediatric infusion practices were also brought under scrutiny to produce
the final draft patient safety alert. The NPSA calls for the introduction
of clinical guidelines for the selection, management and monitoring of
intravenous fluids in children and a review of training and supervision
for all staff involved.
In terms of pharmacy involvement, the NPSA proposes that pharmacists
oversee the removal of all hypotonic infusion fluids from general paediatric
wards and restrict the use of these fluids to paediatric intensive care
settings.
The NPSA welcomes comments and suggestions by 31 March. The consultation
papers and feedback forms are available from the NPSA’s safer health
care website where
a forum has been set up for stakeholders to discuss the initiatives. |
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