Hospital Pharmacy & Secondary / Tertiary Care

RPS launches standards for managing medicines shortages in hospital (April 2013)

RPS has jointly published with the NHS, Best Practice Standards for Managing Medicines Shortages in Secondary Care in England. The Standards provide advice to NHS hospitals in managing medicines shortages at local level to minimise any risks to patients through delays to treatment.Aimed at all staff, particularly Chief Pharmacists, the standards outline guiding principles including collaborative working to ensure that medicines in short supply are used for patients with greatest clinical need.  Steps suggested include prohibiting the sale of medicines to third parties or stockpiling by individual Trusts.The document also outlines 13 specific standards on policy, risk assessment and internal processes that should be addressed in order to minimise the effect of medicines shortages on patients.

Lessons learned from the hospital pathways programme (Dec 2012)

The hospital pathways programme aims to improve both processes of care and interactions between staff and patients through a collaborative programme involving five acute trusts, the King's Fund and the Health Foundation to apply techniques, not widely used in the NHS. This publication describes the programme; the method used to evaluate it; what was learned about the approach, and how the lessons have influenced the next programme called patient and family-centred care.

Dr Foster publishes 2012 hospital guide (Dec 2012)

Dr Foster’s 2012 Hospital Guide reveals the quality of care provided in the NHS and rates trusts on clinical efficiency for the first time.

Driving QIPP through new service improvement projects across Hospital Pharmacy (Dec 2012)

Describes a number of improvement projects aimed to help optimise patient care at Central Manchester University Hospitals NHS Foundation Trust, including a recycling initiative, provision of a pre-op pharmacist for patients scheduled for elective surgery, a night shift for the pharmacy stores and logistics operation, an improved waitiing experience in the paediatric outpatient pharmacy, provision of appropriate information for patients attending the eye hospital, etc. For further information click on this  link

Hospital prescribing - England, 2011  (Nov 2012)

This report compares expenditure between primary and secondary care in total and for selected areas, including medicines positively appraised by NICE. The specific area covered this year is AIDS/HIV. 

Key Facts: In 2011 hospital use accounted for 33.3 per cent of the total cost, up from 31.79 percent in 2010. The cost of medicines rose by 1.9 per cent overall but by 6.9 per cent in hospitals. Of the drugs positively appraised by NICE, the greatest overall cost was for atorvastatin but adalimumab incurred the greatest cost in hospitals. HIV/AIDS treatment is given predominantly through hospitals but while the total cost varies widely, cost per patient is similar. Total prescribing costs in 2011 were £13.1 billion.

Applying 'lean' principles to improve hospital chemotherapy services(Oct 2012)

This articles describes a quality improvement project at Musgrove ParkHospital (Taunton and Somerset NHS Foundation Trust) applying 'lean' change management techniques to all processes relating to chemotherapy prescribing, production and administration.  The resulting changes reduced production run times and patient waiting times, and also reduced staff costs in the chemotherapy unit. For further information click on this link 

Managing risks arising from medicine shortages in NHS hospitals (Oct 2012)

Currently there are no national guidelines in the UK describing how medicine shortages should be managed in hospitals and relatively few NHS hospitals have a locally developed formal written procedure in place.  This article describes how a failure modes and effects analysis (FMEA) identified critical steps in ensuring patient safety when managing medicines shortages in hospitals.  Although it is often not possible to predict when medicine shortages will occur, effective processes for dealing with them and communicating internally and externally can be defined beforehand and will help minimise risks to patients. For further information click on PJ Online website

RPS published new Professional Standards for Hospital Pharmacy Services (Aug 2012)

RPS has launched new Professional Standards for Hospital Pharmacy Services: Optimising patient outcomes from medicines. The standards have been developed by a wide range of stakeholders across GB and covers pharmacy services delivered by acute, mental health, private and community service providers.

The 10 overarching standards underpin patient experience and the safe, effective management of medicines within and across organisations.  They will enable patients to experience a consistent quality of service within and across healthcare providers, that helps protect them from incidents of avoidable harm and enables them to get the best outcomes from their medicines.

The standards will help organisations to ensure their patients receive a consistent quality of service, regardless of where they receive care that helps protect them from avoidable harm and enables them to get the best outcomes from their medicines. It will support chief pharmacists to lead on medicines safety and use in their organisation and provide a framework for the application of professional standards in hospital pharmacy.”

RPS is currently working with a number of development sites across Great Britain to collect data on the use of the standards in practice, to help refine the standards and develop further supporting tools.

The creation of a consistent approach to hospital pharmacy standards from the professional body supports the driver to achieve the highest quality of pharmacy service focussed on Patient Safety and should be welcomed and embraced. These standards have been developed by the profession for the profession, with input from a large number of pharmacy and multidisciplinary organisations across hospital services. The launch of the standards is the culmination of this work and demonstrates strong leadership from the RPS.

The RPS has published a range of supporting resources that include Handbook, FAQs, Executive briefing, and Presentation, alongside the standards to help support implementation. More information about the standards, supporting resources, and the implementation programme visit our website.

Outsourcing hospital pharmacy outpatient dispensing services- Challenges and Opportunities (June 2012)

Hospital pharmacy departments have sought a number of innovative ways to deal with the current financial pressures. Outpatient dispensing (OPD) has been one service where different models have been introduced in recent years and the rate of introduction of new services is increasing rapidly. The models include contracting out the OPD to a third party private provider; creating a limited company (a wholly owned subsidiary) which is associated with the Trust;  using a social enterprise scheme; and increased use of homecare to cover the majority of OPD expenditure. They all have a common element which seeks to take advantage of the fact that outsourcing the provision of hospital pharmacy OPD allows medicines dispensed by the outsourced provider to be exempt from Value Added Tax (VAT). However, the impact on patient care, organisational benefits and any issues arising from each of the different types of service models has yet to be fully assessed. The PDIG (GHP specialist interest group) committee therefore decided to commission a study to compare the different models and assess the potential strategic impact on other hospital pharmacy services and medicines procurement and distribution. The final report can be accessed by clicking on this Link

Electronic prescribing (computerised prescriber order entry): annotated bibliography of publications (Mar 2012)

Papers on electronic prescribing (computerised prescriber order entry) published in 2011 are summarised in this document under a range of headings: effect on outcomes; effect on medication errors and patient safety; other evaluations; system design; alert presentation; drug interaction processing; other usability aspects; implementation; general and miscellaneous. For further information click on this Link

CQC information on essential standards of care services (Feb 2012)

The standards that care services, including hospitals, have to meet and real examples of how they are met can be found on the Care Quality Commission (CQC) website, which also details how the Commission enforces the following standards.

• You should expect to be respected, involved in your care and support, and told what’s happening at every stage
• You should expect care, treatment and support that meet your needs.
• You should expect to be safe
• You should expect to be cared for by staff with the right skills to do their jobs properly
• You should expect your care provider to routinely check the quality of their services.

The Commission has also created a series of booklets to help people understand what they can expect from the care services. For further information click on Link

Medicines security audit results requested from Acute Trusts by DH (Feb 2012)

The Department of Health is asking all NHS acute hospitals to submit results of recent audits of their compliance with published standards for the safe and secure handling of medicines. This is in response to recent concerns about the handling of medicines in hospitals, and to support patient safety. The results of the audits, together with any remedial action plans, should be returned to the Care Quality Commission by 31 March 2012.

See the letter to NHS acute trusts on Medicines security. Download the standards for the safe and secure handling of medicines, published by the Royal Pharmaceutical Society, in The Safe and Secure Handling of Medicines: A Team Approach. In July 2011, Trusts were reminded of the importance of handling and storing medicines in a safe and secure manner.

Delivering sustainable cost improvement programmes (Jan 2012)

The Audit Commission and Monitor have jointly published a guide called Delivering Sustainable Cost Improvement Programmes aimed at acute, ambulance, mental health and specialist NHS trusts and foundation trusts. It summarises how successful organisations approach the delivery of cost improvement programmes. NHS organisations have successfully delivered cost improvement programmes for a number of years, but the challenge is getting tougher. The NHS needs to save up to £20 billion by 2015 – which is an average of 5 per cent per year – the biggest efficiency challenge the NHS has ever faced. To succeed NHS organisations will need to radically transform services. For further information click on more.

Consensus guide on identification of potential high risk injectable medicines (Jan 2012)

NPSA20_high_risk_consensus_list_Dec_2011_final_with_feedback.doc is an update on “Examples of risk assessments of injectable medicine products prepared in clinical areas” originally published by the Joint NHS pharmacy technical services groups in 2007. This is not intended to represent a comprehensive list of all potential high risk injectables and does not obviate the need for assessment of local practice, This guidance is intended to assist NHS Trusts to generate their own high risk injectable medicines list for the purposes of implementing the never event policy. Pharmacists are advised to ensure that local risk assessments have been undertaken for the products and miscellaneous groups listed below (if relevant) and any discrepancies in scoring are reviewed.

In this exercise assessment was restricted to routine administration methods for intravenous injections used in the adult setting. These were identified by reviewing risk assessments compiled by Medusa, UCLH, Imperial, Oxford Radcliffe Hospitals and Guys & St Thomas NHS Foundation Trusts and the Pharmaceutical Press, with additional suggestions from members of the working group. The assigned risk levels were agreed through consensus of group members (listed below). Use of injectable medicines in paediatric and neonatal regimens, and by parenteral routes of administration other than IV are not included in the assessment, although the group has included suggested areas of practice in which  additional local assessment may be warranted. Where relevant, the availability of commercially available ready-to-use products is highlighted as a means of reducing risk. Additionally aseptic preparation in pharmacy CIVAS services or as a “special” from an alternative provider should be considered as a method of reducing the risk associated with preparing high-risk products in clinical areas. Therapeutic alternatives to high risk products should also be considered as a method of reducing risk in some clinical settings. 

Can NHS hospitals do more with less? (Jan 2012)

The Nuffield Trust has published a review of hospital efficiency which found that there are many ways in which hospitals could improve efficiency and reduce the need for cutbacks in services for patients. It cites length of stay and day surgery rates as examples of where there are still opportunities for efficiency to be improved.

Guidance on the New Medicines Service and Medicines Use Review published to support seamless care for patients discharged from hospital (Jan 2012)

The Pharmaceutical Services Negotiating Committee (PSNC) has worked with NHS Employers to develop and publish guidance on how the New Medicine Service (NMS) and post discharge Medicines Use Reviews (MURs) can be used to provide a seamless care pathway for patients who transfer from hospital to the community setting. The guidance has been endorsed by the by the Royal Pharmaceutical Society (RPS).

Support tools are also available for hospitals and community pharmacists to help formalise how information relating to changes to patients’ prescriptions can be shared. A national referral form has also been developed to support the transfer of patient information between hospitals and community pharmacists. The following documents have also been launched to support this process:

• a template patient information leaflet about the benefits of community pharmacy
• a guidance document for community pharmacy about engaging with hospital colleagues
• a guidance document for hospital colleagues about engaging with community pharmacy

Click on this Press release for further information and access to these documents.

NHS Evidence expert commentary: Medicines reconciliation in care transition (Jan 2012)

Achievement of foundation trust status by NHS hospital trusts: sixtieth report of session 2010-12 (Dec 2011)

The Department of Health sees self-governing foundation status as necessary if hospitals are to succeed in a financially demanding environment. Becoming a foundation trust requires strong governance, long-term financial viability, and a framework to secure delivery of quality services. This report finds that the challenges facing those hospitals that have still to attain foundation status are more severe than previously thought. It outlines these problems and makes recommendations for solving these problems in a way that protects taxpayers and patients.

The future of electronic prescribing (Dec 2011)

Implementing electronic prescribing in health care has been a slow process.  Health authorities are now requiring mandatory electronic prescribing because of patient safety concerns.  Electronic prescribing is not yet a mature technology, and may therefore pose a risk, especially if organisational conditions are not taken into account.  This paper offers some thoughts on the future of electronic prescribing in practice.  It is especially important to extend electronic prescribing to the continuum of care in order avoid medication safety falling between the cracks of fragmented health care organisations. For further information click on this Abstract link

Improving practice and reducing risk in the provision of parenteral nutrition for neonates & children (Dec 2011)

The Chief Pharmacists from specialist children’s hospitals were asked by the UK Chief Pharmaceutical Officers to review the current provision of parenteral nutrition (PN) for neonates and children in the UK. The resulting report provides guidance to promote the safety and effectiveness of PN provision, and to clarify (and where possible simplify) the complicated pathway of events beginning with the decision to use PN and to actual administration to the patient. For further information click on this Link

Dr Foster’s Hospital guide published (Dec 2011)

Dr Foster Intelligence, a provider of comparative information on health and social care services, currently part owned by the Department of Health, has published its annual hospital guide, with a focus on mortality rates.The report makes some of the following conclusions (taken directly from source):

• Being admitted to hospital at weekends is risky. Patients are less likely to get treated promptly and more likely to die. The chances of survival are better in hospitals that have more senior doctors on site. But some hospitals with A&E departments have very few senior doctors in hospital at weekends or overnight.
• Delivering safe care 24/7 does not require more resources. Local A&E departments need to identify the services they can provide safely and link with others to provide the services they cannot. 
• London has now achieved the lowest mortality rate following a stroke in England by cutting the number of A&E departments treating stroke from 31 to eight, but making sure those eight provide the highest standards of care. The rest of the country should follow suit.

For further information click on this Link or NHS Choices; NHS Confederation; BBC Health News

e-learning package for falls prevention

The Royal College of Physicians, in collaboration with NHS South of England (Central) and the National Patient Safety Agency, is developing an e-learning package for falls prevention in hospitals. The package is being developed as part of the FallSafe project, and with input from a wide range of professional, patient and NHS organisations and experts in the field of falls prevention, and is being produced by Epic, a company with extensive experience in providing engaging and effective e-learning for healthcare staff. 

The package will be free to staff and organisations providing NHS-funded care in England, and will be accessible via the National Learning Management System (NLMS) and also available for download from the NHS eLearning Repository, as a SCORM-compliant package for users of other learning management systems. The package will cover the key principles of understanding and acting on intrinsic and extrinsic risk factors in the hospital setting. It is intended to provide initial or annual refresher education in falls prevention that is valid and useful in all acute and community hospital settings, despite local variations in the details of their falls prevention policies. Although primarily aimed at nurses, it should be of interest to all clinicians. 

Currently at an advanced scripting stage, it is hoped to launch the package in Spring 2012. For further information please contact lisa.byrne@rcplondon.ac.uk.

RPS Leaders open Pharmacy Department (Dec 2011)

The Society’s President, Martin Astbury, Chief Executive, Helen Gordon and Chair of the English Pharmacy Board, Lindsey Gilpin opened the new Pharmacy Department at the Countess of Chester Hospital. The pharmacists at COCH were able to meet with the RPS officers over lunch and during their walk round the hospital and talk about what the RPS means to them, and what the RPS could do for them. 

Information Centre publishes report on Hospital Prescribing (England 2010)

The NHS Information Centre has published a report comparing the use of medicines in hospitals to that in primary care, and with hospital prescribed medicines dispensed in the community.  The total expenditure is reported and also that for selected areas, including medicines positively appraised by NICE.  Specific topics covered this year include the use of medicines in the management of Attention Deficit Hyperactivity Disorder (ADHD), the treatment of psychoses, and the use of anti-TNF medicines. Key findings reported for 2010 include the following: 

• Overall NHS expenditure on medicines was £12.9 billion
• Hospital use accounted for 31.7% of the total cost, up from 30.9% in 2009
• The cost of medicines rose by 4.8% overall and by 7.7% in hospitals
• Of the drugs positively appraised by NICE, the greatest overall cost was for atorvastatin but adalimumab incurred the greatest cost in hospitals.

Data for use of medicine in hospitals is provided by IMS Health, with costs applied to volume data using the Drug Tariff and standard price lists (the costs may therefore differ to those actually paid as NHS negotiated discounts may be in place, and these are not accounted for).  The data for medicine use in the other two sectors comes from the Prescription Services Division of the NHS Business Services Authority which is responsible for reimbursing those who dispense prescriptions. For further information click on this Link

Professional Standards for Hospital Pharmacy Practice (Oct 2011)

In 2011, the Royal Pharmaceutical Society (RPS) began the development of professional standards that will ultimately create a library of high level professional standards which share best practice for all areas of pharmacy practice. RPS is now in the process of developing professional standards for hospital pharmacy services. The purpose of these standards will be to provide, encompassing high level professional standards that are consistent with regulatory standards and medicines legislation. They will provide a single framework that covers patients from admission through to discharge across multiple care pathways, that can include, for example, outreach care and home care services. 

In order to develop standards that are supportive, realistic and at the same time professionally challenging, RPS is seeking the active engagement of chief pharmacists and their teams. RPS is currently working with a GB wide advisory group of expert pharmacy practitioners, including the Association of Teaching Hospital Pharmacists (ATHP) and the Guild of Healthcare Pharmacists (GHP). The aim is to publish the standards by March 2012. The high level standards will be the start of an ongoing programme that will see RPS working with partners in the profession to develop resources, guidance and gather evidence to support the implementation of the standards. 

If you would like to be involved in the development of these standards, or for more details about the project visit our website or contact Meghna Joshi (Meghna.joshi@rpharms.com) or Catherine Picton (catherinepicton@t-online.de).

Guidelines for design of in-patient prescription charts (Sept 2011)

Professor Sir Bruce Keogh, NHS medical director, Dame Christine Beasley, chief nursing officer and Dr Keith Ridge, chief pharmaceutical officer have written to colleagues about guidelines for design of in-patient prescription charts.

The letter provides information on work by the Academy of Medical Royal Colleges, Royal Pharmaceutical Society and Royal College of Nursing on improving the design of in-patient prescription charts used in hospitals. The department’s aim is to coordinate and stimulate various improvement areas in relation to safe use of medicines, including education and training and good practice guidance.

Guidelines have been published for those organisations and staff involved in the use of medicines to ensure that patients receive their medications safely and effectively. Individual organisations will need to decide on benchmarking their in-patient prescription charts against the recommendations and whether there is a need to improve the drug charts currently in use.

The Royal College of Physicians are currently working to produce a standard chart and their recommendations will be published in due course.  For further information click on the Link to standards 

King’s Fund briefing: Reconfiguring Hospital Services (Sept 2011)

This briefing  from the King’s Fund on reconfiguration calls for radical changes to streamline the process for reorganising hospital services and to prevent politicians from blocking essential changes that would improve the quality and safety of NHS care.  Please click on this link for details.

Call for good practice examples from Martin Stephens, National Clinical Director for Hospital Pharmacy (Aug 2011)

To support the forthcoming changes to the community pharmacy contractual framework  it has been agreed that a national template for referral from hospital to community pharmacy would be helpful. This would foster engagement and help avoid duplicated effort.

NHS Employers are aware that a number of localities will already be looking at this issue and may have implemented a means of doing this in practice. Theywould be keen to see any examples of referral forms or good practice that enables communication between hospital and community pharmacy. Please send any examples and details to Gen Morley at NHS Employers (Genevieve.Morley@nhsemployers.org).

Medicines Reconciliation using a shared Electronic Healthcare Record (Aug 2011)

This study aimed to evaluate the use of a shared electronic primary health care record (EHR) to assist with medicines reconciliation in the hospital from admission to discharge. The most common error type on the discharge prescription was drug omission; and on the EHR, wrong drug.  Common potentially serious errors were related to unidentified allergies and adverse drug reactions. Conclusions of this study are that EHR can reduce medication errors.  However, the EHR should be seen as one of a range of information sources for reconciliation; the primary source being the patient or their carer.  Both primary care and hospital clinicians should have read-and-write access to the EHR to reduce errors at care transitions. For further information about this study click on Abstract link 

RPS Professional Standards for Hospital Pharmacy (Aug 2011)

The RPS would like to hear from pharmacists who are interested in becoming part of its advisory group for producing RPS Professional Standards for Hospital Pharmacy.  The aim is to produce professional standards, underpinned by evidence, which support and enable hospital pharmacists to deliver safe patient care. RPS aims to produce professional standards (maximum 8 – 10 pages) which will be underpinned with additional guidance where necessary, audit templates and service evaluation tools to further build the evidence base for the profession.  The Society aims to gather together and build on what already exists, e.g. the Basel standards and the Joint Commission International standards, and accompany these with examples from practice.

RPS envisage that the standards will be drafted and developed by a small sub group with the wider advisory group providing evidence, comment, expertise, case studies and further information.  The hope is that the advisory group will include representation across all elements of hospital pharmacy and across all areas of GB.   The plan is to publish the standards at the end of 2011 and all contributors will be acknowledged. For further information or to express an interest in joining the advisory group please contact Meghna Joshi, RPS Senior Professional Development Pharmacist on meghna.joshi@rpharms.com

Choice of NHS funded hospital services in England (July 2011)

The Cooperation and Competition Panel for NHS Funded Services has published a discussion paper examining factors which matter to patients and their GPs when they choose a hospital for treatment. These are the factors that hospitals will focus on to attract patients, so this analysis shows how the incentives created by choice and competition will play out. For further information about the Co-operation and Competition Panel click here.

Dispensing label errors: types and causes (July 2011)

Marked differences between prevented and unprevented dispensing incidents have provided new insights into the causative factors.  Researchers undertook a large-scale retrospective analysis of unprevented dispensing incidents reported by hospital pharmacy departments in Wales using manual dispensing systems.  In this study of 1005 incidents, drug errors accounted for 51% and labelling errors for 27%, with combined drug and labelling errors responsible for 16%.  A critical incident technique was developed to further investigate these incidents and was then applied to dispensing label errors at two London NHS Trusts.  As a result of these studies, the authors recommend improved training for pharmacists in checking accuracy and increasing analysis of critical incidents. For further information about this study click on: Journal website

DH reiterates importance for hospitals to have policies in place on the safe and secure handling of medicines (July 2011) 

The Department of Health’s bulletin “the week” contains an article reiterating that to support patient safety, all hospitals should ensure they have in place a robust policy, signed off by the Trust Board, for the safe and secure handling of medicines. Managers and all staff who prescribe, dispense or administer medicines should be familiar with the policy.  NHS chief executives and pharmaceutical officers will wish to review the guidance and ensure that robust policies are in place. RPS guidance: Safe and Secure Handling of Medicines – a Team Approach (2005) 

A quality improvement programme to increase compliance with an anti-infective prescribing policy (July 2011)

The DH has made recommendations on safe and appropriate prescribing of anti-nfectives.  In response, Imperial College Healthcare NHS Trust, London, reviewed its anti-infective policies to ensure they were in line with best practice.  As a result, a new adult anti-infective policy was launched.  To help facilitate its implementation, a quality improvement programme was established, with the aim of achieving higher than 90% compliance with the new policy. 

Over the 11-month study period in 2008, compliance with the policy increased from 30% to 71%.  Since 2008, the average compliance increased year-on-year to over 90% in 2010 using a sustainable once weekly data collection model. This study shows that it is possible to use quality improvement methodology to support antimicrobial stewardship within existing resources and suggests that an improvement in policy compliance can be both achieved and sustained. For further information click on Abstract link

Strategies for optimum treatment of oncology patients (July 2011)

The hospital pharmacy can help to optimise medical treatment for oncology patients not only by providing them with cytostatic drugs.  This article describes with examples from the hospital pharmacy of the St. Johannes Hospital, Dortmund, and the Fulda hospital, both in Germany, the strategies and measures through which the hospital pharmacist can become an essential member of the therapeutic team despite staff shortages and limited financial resources. The full article is available in german at link

A learning-based approach for performing an in-depth literature search using MEDLINE

Exhaustive literature searching is a core requirement for developing guidelines for evidence-based practice. MEDLINE is typically used.  Performing a literature search for retrieving evidence-based studies can be a daunting and error-prone process.  Searching requires the user to identify appropriate search terms, called Medical Subject Headings (MeSH) and refine the search to retrieve relevant articles.  The objective of this study was to develop and test a learning algorithm for conducting a thorough literature search. This algorithm creates combinations of available MeSH terms from which a search is conducted.  

When compared against a static search with a fixed set of keywords implemented by an independent user the learning algorithm retrieved 1670 articles with 6 relevant articles identified.  This compared well to the static search which retrieved a total of 49 articles, with 3 being relevant (These 3 articles were also located from the learning algorithm-based search).  For futher information click on: Abstract link

Literature review on the structure and operation of Pharmacy and Therapeutics Committees (June 2011)

The structure and operating procedures of Hospital Pharmacy and Therapeutics Committees are similar in select Western countries.  The most influential factors in the decision-making of D&T Committees were clinical trial results or drug costs rather than pharmacoeconomic studies.  Other local organisation-dependent factors were also important. To read more click on Abstract link

Adopting real-time surveillance dashboards as a component of an enterprisewide medication safety strategy (June 2011)

High-alert medications are frequently responsible for adverse drug events and present significant hazards to inpatients, despite technical improvements in the way they are ordered, dispensed and administered. Based on inter-pharmacist communication and electronic medical record notes recorded within the dashboards, this study found that interventions to prevent further patient harm were frequent. The researchers concluded that even in an environment with sophisticated computerised provider order entry and clinical decision support systems, real-time pharmacy surveillance of high-alert medications provides an important platform for intercepting medication errors and optimising therapy. For further information click on Abstract link  

Hospital systems for the detection and prevention of adverse drug events (June 2011).

In its 2006 report 'Preventing Medication Errors', the US Institute of Medicine estimated that more than 1.5 million preventable adverse drug events occur annually in the United States.  Many technologies have emerged in recent years to reduce ADEs at various points in the medication use process; however, interfacing some of these key technologies with existing hospital systems still poses significant challenges. Read more about this report by clicking on Abstract link

Scoping the Good Clinical Practice (GCP) Training Needs of Pharmacy Staff involved in Clinical Trials

Clinical trials capacity is very high on the strategic priorities for pharmacy staff. Training for all levels of staff working within the Clinical Trials area is essential.  European and UK Legislation in this priority area require all staff to regularly update their knowledge.  The Medicines Management Academic Unit of The University of Leeds has been commissioned by the National Institute for Health Research (NIHR) Clinical Research Network (CRN) to scope the requirements for GCP training for pharmacy staff involved with clinical trials. Click here for further information and to participate in the survey.

Improving discharge standards for children's medicines (June 2011)

Hassle in the dispensary: pilot study of a proactive risk monitoring tool for organisational learning based on narratives and staff perceptions (June 2011)

This study aimed to prototype a system for identifying and monitoring those organisational processes that give rise to latent conditions that can contribute to failures in a dispensary environment. A proactive risk-monitoring system was prototyped during a 9-month period within the dispensary at Hereford Hospital. The system is used to identify empirically a preliminary set of Basic Problem Factors through qualitative analysis of narratives submitted by pharmacy staff about problems they encountered during their daily work. These factors are monitored and rated based on staff perceptions elicited through a questionnaire. At the concept stage, the system idea was discussed at two stakeholder workshops to ensure plausibility. A Plan–Do–Study–Act approach was used to prototype the system and to evaluate the perceived usability and perceived completeness of the system.

After four Plan–Do–Study–Act cycles, staff were satisfied with the usability of the questionnaire and the choice of factors being monitored. In total, 11 Basic Problem Factors were identified from the narratives, 10 of which have been monitored over a period of 6 months using a questionnaire. The differences in staff perceptions were statistically not significant. The qualitative and quantitative results led to improvements that included a review of all IT equipment in the department and the clean-up of the work environment. 

A system for identifying and monitoring organisational processes that give rise to latent conditions that may contribute to failures was prototyped at the dispensary at Hereford Hospital. This contributes to the organisation's efforts towards creating a proactive safety culture. For further information click on this Link to abstract

Incorrect drug selection at the point of dispensing: a study of potential predisposing factors (June 2011)

 A study analysed medication errors reported over the period January 2005 to December 2008 from the two main dispensaries of a 1200-bed NHS Foundation Hospital Trust in London to determine potential predisposing factors to medication errors involving confusion between drug names, strengths and dosage forms. 

Dispensing incidents considered for analysis included all incidents involving drug name, strength and dosage label and content errors. The Trust recorded a total of 911 dispensing errors between 2005 and 2008. The most significant category, which accounted for 211 (23.2%) of the reported errors, involved errors in drug selection. Drug-selection errors were not random events because the plot of error frequency against the average yearly dispensing frequency for the 1000 most issued drugs showed little evidence of association (r = 0.19, P ()0.03). There was, however, an increased likelihood of drug-selection errors occurring when the prescribed drug was dispensed with relatively low frequency and shows a significant orthographic similarity to another drug which has a higher dispensing frequency. It was concluded that the majority of drug-selection errors would seem to be caused by insufficient attention paid to the specified drug strength. For further information click on this Abstract Link