Article

A national survey of inpatient medication systems in English NHS hospitals

BMC Health Services Research (Impact Factor: 1.66). 02/2014; 14(1):93. DOI: 10.1186/1472-6963-14-93
Source: PubMed

ABSTRACT Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap.
The chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011).
One hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients' own drugs (89%) and 'one-stop dispensing' medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. "Do not disturb" tabards/overalls were routinely used during nurses' drug rounds on at least one ward in 59% of hospitals.
Inter- and intra-hospital variations in medication systems and processes exist, even within the English NHS; future research should focus on investigating their potential effects on nurses' workflow and MAEs, and developing NHS-wide interventions to reduce MAEs.

1 Follower
 · 
85 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Adverse drug reactions, poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause around 2.7-8.0% of UK hospital admissions. Communication gaps between successive healthcare providers exist, but little is known about how MRH is recorded in inpatients' medical records. We describe the presence and quality of MRH documentation for patients admitted to a London teaching hospital due to MRH. Additionally, the international classification of disease 10th revision (ICD-10) codes attributed to confirmed MRH-related admissions were studied to explore appropriateness of their use to identify these patients.
    BMC Health Services Research 06/2014; 14(1):257. DOI:10.1186/1472-6963-14-257 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In contemporary healthcare settings, ensuring patient safety must be an underlying principal through which systems, teams, individuals and environments work in tandem to strive for. The adoption of a culture in the NHS where patient safety is given greater priority is key to improvement. Recent events at Mid-Staffordshire hospitals among others have brought patient safety into the minds of the public and it increasingly demands attention from clinicians, the press and governments. However, much of the work into patient safety has been completed in the secondary care field with very little work completed in primary care settings. In primary care dentistry, improving patient safety is a relatively new concept with a distinct lack of evidence base. In this article, we discuss what patient safety is and debate its relevance to primary care dentistry. We also look at previous work completed in this field and make recommendations for future work to address the current lack of research.
    British dental journal 10/2014; 217(7):339-44. DOI:10.1038/sj.bdj.2014.857 · 1.08 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. Two NHS teaching hospitals in the North West of England. Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The working environment was implicated when nurses lacked healthcare team support and/or were exposed to a perceived increased workload during ward rounds, shift changes or emergencies. Nurses frequently reported that the quality of intravenous dose-checking activities was compromised due to high perceived workload and working relationships. Nurses described using approaches such as subconscious functioning and prioritising to manage their duties, which at times contributed to errors. Complex interactions between active and latent failures can lead to intravenous MAEs in hospitals. Future interventions may need to be multimodal in design in order to mitigate these risks and reduce the burden of intravenous MAEs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    BMJ Open 5(3):e005948. DOI:10.1136/bmjopen-2014-005948 · 2.06 Impact Factor

Full-text (3 Sources)

Download
37 Downloads
Available from
May 20, 2014