|
Liz Mellor is clinical governance lead pharmacist
at Leeds Teaching Hospitals NHS Trust
|
The recent publication of the National Patient Safety Agency safe
medication practice work programme (Hospital
Pharmacist 2007;14:107) has effectively shaped the medicines safety campaign for health care organisations in England and Wales for the coming year. All five of the patient safety alerts are important and challenging.
In particular, patient safety alert 20, “Promoting safer use of
injectable medicines”, is going to require much organisational
commitment and multidisciplinary engagement. The first step of any implementation
programme must be to focus local activity on achieving desired outcomes.
The second, in this instance, must be to ensure that system change results
in sustained improvement.
In accordance with advice from earlier medicines management reports,
most health care organisations should have already developed local policies
supporting the safe management of medicines, including injectable products.
How far these have seeped into the organisational infrastructure and
impacted on patient care appears to be variable.
Data from the National Reporting and Learning System for January 2005–June
2006 show that, although the majority of injectable medicines incident
reports result in low or no harm to patients, there were still 25 deaths
and 28 incidents of severe harm.
It is encouraging that the Department of Health and the Welsh Assembly
Government have recognised the importance of using chief pharmacists
and pharmaceutical advisors to lead the response to the alerts. Those
in these positions have been given a mandate to demonstrate clear and
effective leadership in organisational medicines management issues, as
called for by Keith Ridge, chief pharmaceutical officer for England at
this year’s Hospital Pharmacist conference (Hospital Pharmacist 2007;14:81
(PDF 900K)).
Action
The NPSA alert provides six key recommendations for action and presents
tools and supporting templates to help organisational engagement. For
those who have policies and procedures in place, cross-checking the detail
with that recommended by the NPSA should be relatively straightforward.
For those starting from scratch, the tools and templates require minimal
local review and adaptation to begin the process.
It is important that any work originating from the patient safety alerts
builds on local successes and develops good practice models that can
be shared across similar NHS organisations. All activity should be influenced
by an understanding of local needs and priorities.
It is pivotal to undertake a risk assessment of injectable medicine procedures
and products in use in all clinical areas. Some work has already been
done independently1,2 through project sponsorship3 and as part of the
NPSA safety alert development programme.
Although pharmacy teams can direct and co-ordinate this action, effective
engagement of local nursing, medical and other health care professionals
(within management and clinical teams) will determine long term success.
Working together
Applying the proposed NPSA work competencies to all those working with
injectable medicines will require links to existing multidisciplinary
medicines management support structures. Where these do not already exist,
the development of new links within the organisational framework is likely
to be key to success.
We should aim to avoid any unnecessary duplication of work and, once
risk assessments have been conducted, effective links to local manufacturing
and production and procurement networks will be essential in responding
to changes in local product and process needs.
A wider spread of procurement hubs promoting “purchasing for safety” policies
will be important in working with the industry to encourage new injectable
products and formulations to support patient safety.
One early outcome from the recent alert is the new partnership between
the injectables guide, co-ordinated by the Hammersmith Hospitals NHS
Trust, and the UK Medicines Information Services. This partnership aims
to support the expansion and development of the resource for a wider
audience. However, in the interim, organisations will need to consider
local solutions to support access to relevant technical information at
the point at which their health care staff need it.
Many may see financial pressures as a significant obstacle to implementing
the alert. Although ready-to-use injectable products can often be calculated
as being cost neutral when replacing products requiring high risk manipulation
in clinical areas, the reality of releasing budget from one allocated
purpose to another is challenging. This highlights the importance of
an organisational approach and strong leadership to ensure
co-operation at all levels of management and clinical care.
Although more challenging in the short term, multidisciplinary implementation
will differentiate those organisations which are serious about addressing
risks in latent systems from those who are looking for a quick fix.
Although chief pharmacists, pharmaceutical advisors, clinical governance
leads and risk managers have their work cut out for them in order to
meet the March 2008 deadline for the NPSA actions to be complete, seizing
the opportunity provided by this work programme can only enhance the
clinical role of the pharmacist within the NHS.
References
1 Munro MJ, Millar BW, Radley AS. A risk assessment of the preparation
of parenteral medicines in clinical areas. Hospital Pharmacist 2003;10:303–5.
2 Beaney AM, Black A, Dobson CR, Williamson S, Robinson M. Development
and application of a risk assessment tool to improve the safety of patients
receiving injectable medicines. Hospital Pharmacist 2005;12:150–4.
3 Hardy L, Mellor L. Risk Assessment of parenteral product preparation
across secondary care acute trusts in the North of England. Hospital
Pharmacist 2007;14:58–64.
|
Hospital Pharmacist