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Found 182 results
  1. Community Post

    Better use of data for medication safety in hospitals

    Kenny Fraser

    Kenny Fraser posted a topic in Medicine management

    NHS hospital staff spend countless hours capturing data in electronic prescribing and medicines administration systems. Yet that data remains difficult to access and use to support patient care. This is a tremendous opportunity to improve patient safety, drive efficiencies and save time for frontline staff. I have just published a post about this challenge and Triscribe's solution. I would love to hear any comments or feedback on the topic... How could we use this information better? What are hospitals already doing? Where are the gaps? Thanks
  2. Community Post
    In unit-dose dispensing, medication is dispensed in single doses in packages that are ready to administer to the patient. It can be used for medicines administered by any route, but oral, parenteral, and respiratory routes are especially common. The system provides a fully closed loop process where the patient, the drug and the healthcare professional are identified by machine readable codes and the drug administration process is linked directly to the electronic prescription. and is fully recorded There are many variations of unit-dose dispensing. As just one example, when physicians write orders for inpatients, these orders are sent to the central pharmacy . Pharmacists verify these orders and technicians place drugs in unit-dose carts. The carts have drawers in which each patient's medications are placed by pharmacy technicians—one drawer for each patient. The drawers are labelled with the patient's name, ward, room, and bed number. Sections of each cart containing all medication drawers for an entire nursing unit often slide out and can be inserted into wheeled medication carts used by nurses during their medication administration cycles. Alternatively, electronic medicine storage cabinets can be located on wards and these are attached to medicine carts which are then filled from the cabinets. Studies often compare unit-dose dispensing to a ward stock system. In this system, bulk supplies are issued from the pharmacy; the drugs are stored in a medication room on the ward. The correct number of doses must be taken out of the correct medication container for each cycle and taken to the patient for administration. Liquids must be poured by the nurse from the appropriate bottle and each dose carefully measured. Evidence for Effectiveness of the Practice Though the practice of unit-dose dispensing is generally well accepted and has been widely implemented, the evidence for its effectiveness is modest. Most of the published studies reported reductions in medication errors of omission and commission with unit-dose dispensing compared with alternative dispensing systems such as ward stock systems. Potential for Harm Unit-dosing shifts the effort and distraction of medication processing, with its potential for harm, from the ward to central pharmacy. It increases the amount of time nurses have to do other tasks but increases the volume of work within the pharmacy. Like the nursing units, central pharmacies have their own distractions that are often heightened by the unit-dose dispensing process itself, and errors do occur. Overall, unit-dose appears to have little potential for harm. The results of most of the observational studies seem to indicate that it is safer than other forms of institutional dispensing. However, the definitive study to determine the extent of harm has not yet been conducted. A major advantage of unit-dose dispensing is that it brings pharmacists into the medication use process at another point to reduce error. Yet about half of the hospitals in a national survey indicated that they bypass pharmacy involvement by using floor stock, borrowing patients' medications, and hiding medication supplies. Unit dose drug distribution is being introduced across Europe. In Germany, a recent study showed a saving of 2.61 WTE nurses per 100 beds. There is now growing interest in UK hospitals and pilot sites to develop the system are being established.
  3. Content Article
    Medication nonadherence - when patients don’t take their medications as prescribed - is unfortunately fairly common, with research showing that patients don’t take their medications as prescribed about half the time. The phenomenon has added consequences for patients with chronic disease. When this is the case, it is important for physicians and other health professionals to understand why patients don’t take their medications. This will help teams identify and improve patients’ adherence to their medications. This article by AMA, highlights eight reasons why patients don't take their medications.
  4. Content Article
    Community pharmacies are offering an increased range of services to support care for people in the community. It is therefore essential that they are able to record and share vital information about a person’s care with GP practices and other services. Using digital standards, we can ensure that care professionals and citizens have timely access to relevant information, leading to better, safer and more personalised care in the community. This Community Pharmacy Standard developed by the Professional Record Standards Body (PRSB) defines the information that should be recorded in the community pharmacy and sent to the person’s GP, for all the services covered by the English Community Pharmacy Contractual Framework.
  5. Content Article
    Medicines can be purchased online from anywhere in the world. In 2021, nearly 53 million items were dispensed from online pharmacies in England, up 300% since 2016. In this blog, Dr Georgia Richards outlines the need for caution when buying medicines online, highlighting that online purchase of medications was cited in 16 Prevention of Future Deaths (PFD) reports between 2013 and 2019. She highlights coroners concerns concerns about: the ease of obtaining drugs via the Internet without any contact with the patient’s medical practitioner or access to the patient’s records. the inability to limit the volume or the frequency of ordering. issues with the regulation of supply, importation and delivery of controlled class A drugs via the international and UK postal system. lack of regulation of the dark web.
  6. Content Article
    This editorial in The Guardian looks at the Government's approach to relieving pressure on GPs, which involves diverting patients to other areas of primary care, including pharmacies. The article highlights potential risks and issues associated with the approach, including the workforce issues currently facing community pharmacy and the comparative lack of standards and regulations for pharmacies. It argues that the Government's approach simply moves the issue to other areas of the healthcare system, rather than dealing with the root cause of the issue facing GP surgeries—retention and recruitment.
  7. Content Article
    This article summarises the findings of research by Healthwatch into the impact of the cost of living crisis on people's decisions about accessing health and care. The research, which surveyed 2000 adults in England, was conducted four times between October 2022 and March 2023. It suggests that people are increasingly avoiding vital health and care services due to the fear of extra costs. Examples include avoiding:   going to a dentist because of the cost of checks ups or treatment  booking an NHS appointment because they couldn’t afford the associated costs, such as accessing the Internet or the cost of a phone call  buying over the counter medication they normally rely on  taking up one or more NHS prescriptions because of the cost. Healthwatch sets out a series of recommendations, including ensuring that the support available to help with healthcare costs is communicated to those that need it.
  8. News Article
    The National Pharmacy Association (NPA) has asked community pharmacies to report all patient safety incidents despite growing work pressure due to a persisting virus pandemic. Since March, there has been a significant decrease in the number of patient safety incidents being reported, the NPA said in its medication safety update for the second quarter of 2020. Overall, there was a 44.5% decrease in the number of incidents reported during the second quarter of the year, compared to the first quarter of 2020. There was a 40.6% decrease in the number of patient safety incidents when compared to the same quarter in 2019. “This is a significant reduction in number of incidents being reported. This may be due to the increased workload and pressure on pharmacy teams due to COVID-19 pandemic, whereby pharmacy teams may not be prioritising reporting of patient safety incidents, or due to other, as yet unknown, reasons,” NPA said in its update. NPA advises community pharmacists to ensure that they report the actual degree of harm caused to the patient and not the potential harm that could have happened. The pharmacy body also suggested pharmacists should make sure that they complete a detailed outcome if an incident did lead to moderate or severe harm to the patient. This allows a thorough analysis to be undertaken by the NPA. Community pharmacists are also advised to ensure the incident form is fully completed, is accurate and includes sufficient details to allow meaningful analysis of the incident. Read full story Source: Pharmacy Business, 27 October 2020
  9. News Article
    A pharmacist-led, new digital intervention that improves patient safety when prescribing medication in general practice reduced rates of hazardous prescribing by more than 40%, 12 months after it had been introduced to 43 GP practices in Salford, finds a new study. Due to its success, plans are underway to roll it out across Greater Manchester. Prescribing and medication are one of the biggest causes of patient safety incidents and the third WHO Global Patient Safety Challenge is focussed on Medication without Harm. The SMASH intervention addresses this. It was developed by researchers at the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), which is a partnership between The University of Manchester and Salford Royal hospital in collaboration with The University of Nottingham. Pharmacists working in general practice use the SMASH dashboard to identify patients who are exposed to potentially hazardous prescribing. For example, patients with a history of internal bleeding may be prescribed medications such as aspirin which could increase the risk of further internal bleeds without prescribing other treatments to protect them. SMASH identifies this and warns healthcare professionals about it, who can then decide on a possible course of action. The intervention is unique due to its ability to provide near real time feedback to prescribers as it updates every evening. Professor Darren Ashcroft, Research Lead for the Medication Safety theme at the GM PSTRC, said: "We worked with the Safety Informatics theme at the GM PSTRC to develop then test SMASH. It is designed to improve patient safety in general practice by reducing potential problems made when prescribing medication and inadequate blood-test monitoring. It brings together people and data to reduce these common medication safety problems that all too often can cause serious harm." Read full story Source: EurekAlert, 14 October 2020
  10. News Article
    Guy’s and St Thomas’ NHS Foundation Trust will work with Omnicell to develop a European technology-enabled inventory optimisation and intelligence service which will be initially implemented across South East London Integrated Care System (ICS). This partnership will encompass all six acute hospital sites within the South East London ICS, including Guy’s & St Thomas’, Kings College Hospital NHS Foundation Trust and Lewisham & Greenwich NHS Trust. The project will have the following goals: Develop analytics and reporting tools with a goal of improving patient safety, achieving increased operational efficiency and cost efficiencies Utilize the analytics and reporting tools with a goal of achieving agreed efficiencies and cost reductions Demonstrate the impact of managing clinical supplies and medicine spend together at scale Build a service model for the ICS which can be scaled up and adopted by other hospital groups in the UK Read the full article here
  11. News Article
    Pharmacists will be allowed to write prescriptions under plans reportedly being considered by England's Health Secretary Sajid Javid. Mr Javid last month vowed the Government will "do a lot more" to ensure GPs see more patients face-to-face following complaints from the public. The proposals would see more prescriptions provided through pharmacies and hospitals for routine illnesses to allow doctors more time to see patients in person, according to The Sunday Times. GPs will also reportedly be able to pass off bureaucratic processes such as providing supporting medical evidence to the Driver and Vehicle Licensing Agency (DVLA) over a patient's fitness to drive. The plans are expected to include sanctions for doctors who do not increase the number of face-to-face appointments with patients, the paper added. Read full story Source: 11 October 2021, Medscape
  12. Event
    until
    Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. WHO Patient Safety Flagship has initiated a series of monthly webinars on the topic of “WHO Global Patient Safety Challenge: Medication Without Harm”,. The main objective of the webinar series is support implementation of this WHO Global Patient Safety Challenge: Medication Without Harm at the country level. Considering the huge burden of medication-related harm, Medication Safety has also been selected as the theme for World Patient Safety Day 2022. Ensuring medication safety in polypharmacy is one of the critical challenges in medication safety. Inappropriate polypharmacy has been described as a significant public health challenge, as it increases the likelihood of adverse effects, considerably impacting health outcomes and expenditure on health care resources. Countries need to prioritize raising awareness of the problems associated with inappropriate polypharmacy and the need to address this issue. All stakeholders have a vital role in driving change for the management of polypharmacy. At this webinar, we will introduce the WHO technical report on “Medication Safety in Polypharmacy”, and experiences from different countries and organizations will be shared on the proper management of polypharmacy and the factors that influence appropriate polypharmacy. The session will be available in English, French and Spanish. Register for the webinar
  13. Event
    until
    This webinar by the Institute for Safe Medication Practices in the US is aimed at: Pharmacists, physicians, nurses Medication safety officers Quality professionals Risk managers Leaders in pharmacy and nursing Pharmacy and anaesthesia technicians Although most medications in healthcare today have a wide margin of safety, there remains some which can cause serious harm or death if they are misused. To reduce the risk of error with these “high-alert” medications, special precautions and high leverage strategies should be implemented to avoid serious patient safety events. Numerous organizations have taken steps to identify these medications, but many are still less than confident that they have taken all the necessary precautions against serious patient harm. Join the ISMP faculty as we focus particular attention on the potential safe use risks with heparin, concentrated electrolytes, and magnesium using the results from ISMP’s National Medication Safety Self Assessment® for High-Alert Medications. Faculty will review specific safety characteristics of each these important drug classes, describe self-assessment findings related to the use of these medications, and discuss the necessary practice strategies for harm prevention when using these high-alert medications. Register for the webinar 3.00pm Eastern Time (US and Canada), 8.00pm GMT
  14. Event
    until
    This webinar by the Institute for Safe Medication Practices in the US is aimed at: Pharmacists, physicians, nurses Medication safety officers Quality professionals Risk managers Leaders in pharmacy and nursing Pharmacy and anaesthesia technicians Although most medications in healthcare today have a wide margin of safety, there remains some which can cause serious harm or death if they are misused. To reduce the risk of error with these “high-alert” medications, special precautions and high leverage strategies should be implemented to avoid serious patient safety events. Many organizations have taken steps to identify these medications, but many are still less than confident that they have taken all the necessary precautions with high-alert drugs against serious patient harm. Join the ISMP faculty as we examine and define the importance of high alert medications as part of routine patient care and review the results of ISMP’s National Medication Safety Self Assessment® for High-Alert Medications with particular attention to vasopressors and insulin. Faculty will review specific safety characteristics of each these important drug classes, describe self assessment findings related to the use of these medications and discuss the necessary strategies for harm prevention when using these medications. Register for the webinar 3.00pm Eastern Time (US and Canada), 8.00pm GMT
  15. Content Article
    This open letter from the Pharmacists' Defence Association (PDA) raises concerns about unnecessary full or part-day closures of community pharmacies throughout the UK by some large multiple pharmacy operators. The letter states that these operators are telling patients and the government that they have been unable to find pharmacists, citing an alleged national pharmacist shortage. However, the PDA's members report that this is not the case, and the letter draws attention to closures being planned four weeks in advance, and to locum pharmacists having agreed rates of pay reduced at the last minute. The PDA highlights the risk to patient safety caused by these closures, and calls for more regulatory action to be taken by the government and other regulators. The letter is addressed to: Government Health Secretaries of England, Northern Ireland, Scotland and Wales Chief Executives of the National Health Service in England, Northern Ireland, Scotland and Wales NHS Chief Pharmaceutical Officers for England, Northern Ireland, Scotland and Wales Chief Executive of General Pharmaceutical Council and Pharmaceutical Society of Northern Ireland.
  16. Content Article
    The purpose of these standards is to create and maintain the right environment, both organisational and physical, for the safe and effective practice of pharmacy. The standards apply to all pharmacies registered with the General Pharmaceutical Council. 
  17. Content Article
    These professional standards describe good practice and good systems of care for reporting, learning, sharing, taking action and review as part of a patient safety culture. The accompanying guidance and information support the implementation of the standards. These professional standards are for pharmacists, pharmacy technicians and the wider pharmacy team across the United Kingdom. This may also be of interest to the public, to people who use pharmacy and healthcare services, healthcare professionals working with pharmacy teams, regulators and commissioners of pharmacy services.
  18. Content Article
    Pharmacists and pharmacy technicians across different settings work hard to provide person-centred, safe and effective care to patients. But, in reality sometimes things go wrong. The way that professionals respond to these situations is key to supporting the people affected and improving patient safety for the future. This guidance from the General Pharmaceutical Council aims to provide you with guidance on how to implement the Duty of Candour.
  19. Content Article
    Pharmacy teams may want to develop or implement new services in their organisations to realise quality, safety and operational benefits and financial efficiencies, or to improve the patient experience. The Pharmaceutical Journal highlights eight steps pharmacists should follow to ensure that a business case is as robust as possible.
  20. Content Article
    This is the final report of the stocktake undertaken by Dr Claire Fuller, Chief Executive-designate Surrey Heartlands Integrated Care System and GP on integrated primary care, looking at what is working well, why it’s working well and how we can accelerate the implementation of integrated primary care (incorporating the current 4 pillars of general practice, community pharmacy, dentistry and optometry) across systems.
  21. Content Article
    This article discusses how medication safety can be improved in Canada. It explores the complexities of aging, what can go wrong with medication, 'Best Possible Medication Histories', the role of pharmacists and paramedics, engaging with patients and their families, and improving communication across the healthcare system.
  22. Content Article
    Minutes from the General Pharmaceutical Council meeting held on 14 July 2022. To be confirmed 8 September 2022.
  23. Content Article
    The US Institute for Safe Medication Practices (ISMP) list of error-prone abbreviations, symbols, and dose designations contains abbreviations, symbols, and dose designations which have been reported through the ISMP National Medication Errors Reporting Program (ISMP MERP) and have been misinterpreted and involved in harmful or potentially harmful medication errors. These abbreviations, symbols, and dose designations should NEVER be used when communicating medical information verbally, electronically, and/or in handwritten applications. This includes internal communications; verbal, handwritten, or electronic prescriptions; handwritten and computer-generated medication labels; drug storage bin labels; medication administration records; and screens associated with pharmacy and prescriber computer order entry systems, automated dispensing cabinets, smart infusion pumps, and other medication-related technologies. 
  24. Content Article
    In the UK, over 26% of adults take prescription medications and in the US the figure is around 66%. But up to 50% of patients fail to take their medications as prescribed. As healthcare steadily pivots towards digital health, Dr. Bertalan Meskó and Dr. Pranavsingh Dhunno ask how new technologies can improve medication management. In this article for The Medical Futurist, they look at the importance of empowering patients to reduce the risk of medication errors. They highlight five medication management technologies that could help patients improve their own medication safety: Smart pill dispensers which deliver audible and visual cues to remind patients to take medications at the right time Medication reminder apps which help manage medication regimens and can sync the data with a caregiver or doctor Digital therapeutics which support patients to make treatment decisions Digital pills which integrate tracking technology into pills themselves Telemedical platforms that allow patients to request advice or raise concerns with their doctors.
  25. Content Article
    This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Angela talks to us about how her role enables her to promote collaboration for patient safety between different layers of the healthcare system. She also tells us about how Northern Ireland is using World Patient Safety Day 2022 to help the public and healthcare staff understand how they can contribute to medication safety.
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