The Pharmaceutical Journal
Vol 276 No 7401 p590
20 May 2006

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· Intervention recording
· Packaging
· National Health Service
· Remote supervision
· Council election
· Fitness to practise (3)
· Education

Letters to the Editor

Intervention recording

Guidance on recording interventions welcome but disappointing

From Mr C. Acomb, MRPharmS

I welcome the Royal Pharmaceutical Society’s guidance on recording of interventions (PJ, 29 April, p517 PDF (50K)). However, I am disappointed with some of the content. In general, as a profession we have been poor at documenting the care we provide to patients and although this guidance is a step forward I think it is a missed opportunity. The guidance mixes two types of health care intervention which I believe should be thought of as separate areas of practice. Furthermore the guidance does not encourage pharmacists to make entries in the patient’s multidisciplinary health care record or be part of the health care team but sees us largely working in isolation.

Interventions that prevent harm to patients by correcting errors in prescribing (or administration) are reactive interventions. Recording of these incidents and near misses should be an important part of clinical governance arrangements for both primary and secondary care pharmacists. I think the guidance does not place enough emphasis on sharing this information with prescribers and other health care professionals. These incidents and near misses should contribute to the continuous improvement in the quality of the prescribing process. Analysis of these near misses, looking for similar error types or error trends, will help identify a process that needs revising. In Leeds Teaching Hospitals (and in many other hospitals) these near misses are fed back to consultants and clinical management teams at regular intervals. Examples are used in the teaching of medical students and junior doctors. Importantly a reduction in the number of these “interventions” (near miss records) may be viewed as a positive sign of error reduction and safer practice.

One difficulty is in deciding what is a significant incident or near miss. In the Yorkshire hospitals we have introduced a matrix that considers consequences to the patient and likelihood of a detrimental effect occurring (see below). Incidents and near misses that fall in the shaded area are regarded as serious and always documented. The other incidents and near misses should not be ignored but collected intermittently over fixed periods. Collecting significant incidents and near misses continuously, and less serious incidents on an intermittent basis, helps prevent recording fatigue. To maintain momentum in recording near misses, where a group of pharmacists all contribute to a near miss database, it is important that the contributors see use being made of their records and action taken.

Interventions where the pharmacist makes a health care assessment, or provides information to a patient (or other health care worker), or refers a patient to another health care professional, are proactive health care interventions. These should be considered separately to the previously mentioned records of incidents and near misses. An increase in these proactive interventions can be viewed as an indication of an active health care professional. The guidance mentions making an entry in a patient medication record. However I believe strongly that wherever possible these care plans or actions should be documented in the patient’s multidisciplinary health care record. Where appropriate, outcomes should be recorded so that other members of the health care team can see the issues the pharmacist has dealt with. If the pharmacist keeps separate records this means that the patient’s health care record is incomplete. Pharmacists are sometimes their own worst enemies at moving forward and becoming an integral part of the health care team.

Chris Acomb
Clinical Pharmacy Manager (Professional Development)
Leeds Teaching Hospitals NHS Trust

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