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Letters
S.Keeling and P.Golightly
R.Miles
Reply: Liz Mellor
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Letters to the editor
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From S.Keeling MRPharmS and P.Golightly MRPharmS
We are writing with reference to the Comment entitled “The
year of the injectable? — an organisational approach” (Hospital
Pharmacist 2007;14:146), which advises trusts to produce their own
local intravenous medicines guide.
We would argue against this and would
discourage
the proliferation of yet more local intravenous guides. Producing such
a guide is time consuming and expensive. It requires constant updating
and is out of date as soon as it is published.
‘The IV guide’, which is co-ordinated by the pharmacy department
at Hammersmith Hospitals NHS Trust, is a collaboration between pharmacists
based in approximately 100 different hospitals in the UK. It is described
in the National Patient Safety Agency’s patient safety alert 20, “Promoting
safer use of injectable medicines”.
The current IV guide is being
updated to fully meet the NPSA essential technical information requirements.
It is available free of charge to all hospitals who participate in
monograph preparation.
The website contains examples of product risk assessments, and each
individual monograph will shortly describe the appropriate risk assessment
for the
product as required by the NPSA alert. It should be remembered that
product risk assessment will not vary from one hospital to another
and the production
of a local list is unnecessary.
The IV Guide Group has worked with the Intensive Care Society, the
UK Clinical Pharmacy Association Critical Care Group and other national
organisations to carry out a survey of the concentrations of intravenous
medicines currently in use in critical care areas. The results of this
survey and suggested standards have recently been published.1
The Intensive Care Society are actively encouraging all critical care
areas to adopt the suggested standards and a further survey tackling
another group of injectable medicines is planned.
Standardisation of infusion concentrations used throughout the NHS
should facilitate production of national monographs, help in the development
of robust and uniform computerised prescribing systems and encourage
development of a range of ready-to-use formulations. In the future,
if
local practice is found to differ to national practice, a local risk
assessment would be required to support its continued use.
At present, the IV Guide Group and UK Medicines Information (UKMi)
are collaborating to develop the IV Guide into a robust NHS injectables
medicines
guide which will be free to NHS users. In the meantime, the current
IV Guide relies on the support of pharmacy departments nationally. Susan Keeling
Co-ordinator of the IV Guide Group,
Hammersmith Hospitals NHS Trust
Peter Golightly
Director, Trent Medicines Information Service, Leicester Royal Infirmary
(on behalf of UKMi)
Reference
1. Borthwick M, Woods J, Keeling S, Keeling P, Waldmannthat C. A survey
to inform standardisation of intravenous medication concentrations in
critical care. Journal of the Intensive Care Society 2007;8(1):92–6.
From R.Miles MRPharmS
The otherwise excellent Comment
on injectable medicines (Hospital Pharmacist
2007;14:146) includes the sentence: “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”.
This statement must not go without challenge. Not only does it not recognise
the effort put in over many decades by hospital pharmacists to work with
the industry to produce better products, but it indicates that the future
of pharmaceutical procurement is with procurement hubs.
Specialist procurement and quality control pharmacists have, over many
years, met manufacturers, the Medicines and Healthcare products Regulatory
Agency, the National Patient Safety Agency, and specialist sections of
the Department of Health, with the express purpose of making products
available in safer presentations, with improved packaging and labelling
being of major consideration.
It was hospital pharmacists who developed the “Medication error
potential analysis” tool. This tool, which quantifies the risk
inherent in packaging design, is used by the adjudication panels for
NHS hospital contracts, and manufacturers are now becoming more aware
of the importance of packaging design in securing tenders.
Contrast this
track record with that of procurement hubs, where not a single example
of a procurement hub being proactive in patient safety can be cited.
The author is mistaken if she believes that patient safety will be secured
by procurement hubs.
National policy, recently agreed by the National Pharmaceutical Supplies
Group and the Joint Category Working Group of the procurement hubs, says
that the procurement of medicines should be in the hands of hospital
pharmacists, supported by the expertise of staff from the NHS Purchasing
and Supply Agency. All the evidence supports the wisdom of this decision.
Let the procurement hubs stick to the purchase of bandages and blankets — they
have no future with medicines. Hospital pharmacists must recognise their
professional responsibility — getting the right medicines to the
right patient at the right time — and this requires investment
in training and support of regional specialist pharmacists. Roger Miles
Regional specialist Procurement Pharmacist (North West)
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LIZ MELLOR, clinical governance lead pharmacist at Leeds Teaching Hospitals
NHS Trust and author of the Comment responds:
I agree wholeheartedly with the sentiments of these letters and apologise
if my Comment was ambiguous.
My statement “in the interim, organisations will need to consider
local solutions to support access to relevant technical information” was
not intended to suggest the production of local IV guides, rather that
organisations must look at their own local circumstances and ensure they
have considered how information is made available at the point at which
their health care staff require it. Locally, for example, we have identified
isolated locations where direct access to web-based resources is currently
problematic and are working on solutions to resolve this.
The Hammersmith Hospitals NHS Trust co-ordinated IV Guide is currently
one of the ways to access technical information and duplication of information
should be avoided. I too would suggest that those hospitals which do
not collaborate in this resource should take the time to review it and
consider how it may be used as part of their own local programme of work.
I am a proponent of structures which harness the expertise of the pharmacist
in pharmaceutical procurement. I did not intend to imply that procurement
hubs would secure patient safety alone. It would, however, seem essential
that specialist pharmacists demonstrate leadership and exert their influence
across all effective boundaries.
I am aware that the way in which medicines procurement and procurement
hubs interact is variable across the country. In my Comment I aimed to
point out that, where procurement hubs have any involvement in medicines
purchasing, specialist pharmacists need to influence these processes.
Procurement hubs need to be engaged with purchasing for safety processes. |
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Hospital
Pharmacist