Abstract
BackgroundSystems 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.MethodsThe 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).ResultsOne 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.ConclusionsInter- 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.
Highlights
Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs)
Little is known about 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
This survey reported that 9% of hospitals had a resident on-call pharmacist and 88% had a non-resident on-call service to provide advice and support medication supply outside of pharmacy opening hours. These data are over 20 years old and various national medication safety and quality initiatives have since been introduced in NHS hospitals. These include the use of electronic prescribing and medication administration (EPMA) systems, the use of patients’ own drugs (PODs) during hospital inpatient stays, one-stop dispensing (OSD) supplies which are hospital inpatient medications labelled with administration instructions for use at discharge as well as during the inpatient stay, and patient bedside medication lockers [21,22,23]
Summary
We conducted a national cross-sectional postal census of English NHS hospital inpatient medication systems in July 2011. A pre-notification letter was sent to the chief pharmacist at each trust in June 2011, followed by an invitation to complete a questionnaire relating to inpatient medical and surgical wards in their main acute hospital in July. The questionnaire (see Additional file 1) comprised two parts with questions relating to medication systems and processes in part 1, and more detailed questions relating to any electronic prescribing systems used in part 2 (data presented elsewhere) [26]. Three other closed questions had multiple parts; these involved the respondent selecting one option from three (“yes”, “no”, “not sure”) in response to whether a specific administration-related policy or guidance was available. For questions relating to the proportion of wards that used a specific system or process, responses for ‘all wards’ and ‘most wards’ were combined into ‘majority of wards’ in our analysis of inter-hospital variation. The Joint Research Office at Imperial College London and Imperial College Healthcare NHS Trust confirmed that NHS research ethics approval was not required as the study was considered to be service evaluation
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