Time critical medication QIP 2023-24: Interim report year 1 (Royal College of Emergency Medicine, 7 April 2025)

Summary

Patient safety is being put at risk in Emergency Departments due to missed doses of vital prescription medicines. This is one of the findings of a study being carried out by the Royal College of Emergency Medicine (RCEM) which revealed that many patients who rely on prescription medication to manage chronic conditions such as diabetes and Parkinson’s, aren’t always getting these vital drugs when in A&E.

These types of drugs are known as ‘time critical medication’ (TCM) and, as the name suggests, it is important they are taken at specific times. If a dose is delayed or missed, it can cause a person’s health to worsen. And if this delay is prolonged, the consequences can be severe.

The RCEM’s new report – Time Critical Medication QIP 2023-24 is part of the College’s clinical Quality Improvement Programme  (QIP), which aims to improve the care of patients attending Emergency Departments. The three-year QIP examines how time critical medications are dealt with in practice when patients come to the Emergency Department and how clinical methods and patient safety can be improved. This report reflects the findings of the first year of the programme.

Content

Across the UK, 136 Emergency Departments collated and analysed data for people living with diabetes and Parkinson’s, who take certain medication such as insulin injections and a drug called levodopa, taken as tablets or capsules.

Supported by Parkinson’s UK and Diabetes UK, the QIP found more than half of eligible patients (53.4%) taking TCM weren’t identified within 30 minutes of their arrival in ED. Meanwhile, around 68% of eligible patients’ doses weren’t administered within 30 minutes of the expected time.

In response to the findings, the QIP team made the following recommendations:

• Patients on TCM need to be identified early to start the process of getting all doses whilst in the ED.
• Systems need to be in place that will facilitate the timely administration of TCM, including self-administration.
• Local EDs must have a clear governance structure in place to determine who is responsible for the prescribing and administering of TCM in the ED from when the patient arrives, to when they are admitted to the ward or discharged from the ED.

Further reading on the hub:

• Time-critical Parkinson’s medication: the human cost of delays and mistakes
• HSSIB investigation report: Medication not given: administration of time critical medication in the emergency department
• Parkinson's UK: Time critical medication guides for health professionals
• Improving safety for diabetic inpatients: 4 key steps
• D1abasics: Equipping staff to care safely for inpatients with diabetes