‘No Needless Medication Errors’ Gillian Honeywell, Chief Pharmacist NHS Isle of Wight South Central

Medication Errors do happen.. Why was this workstream chosen? South Central

Facts and figures Medicines are the most frequently used healthcare intervention 97% of all hospital patients take a medicine 6% of hospital admissions are a direct result of problems with medicines including side effects1 Poor communication between care settings is responsible for up to 50% of all medication errors & up to 20% of adverse drug reactions that occur in hospital 2 Average DGH has 350 medication errors per day NPSA: medication errors account for 9% total Pharmacy in England Building on strengths – delivering the future, Department of Health. 2008 NICE/NPSA patient safety guidance to improve medicines reconciliation at hospital admission. National Patient Safety Agency. December 12 2007 available from http/www.npsa.nhs.uk/corporate/news/guidance-to-improve-mrdicines-reconciliation/ South Central

Project Plan Project 1: Metrics: 3rd year: Improvement Methodology: Trust Quality Standard kpi’s and SHA monitoring 1: Means of ensuring patient receive oral anticoagulation therapy within safe parameters (INR >5 & >8) 2: Medicines reconciliation: safer admission to hospital: patients’ medicines are reconciled within 24 hours of admission 3: Allergies: A means of ensuring that patients allergy status is recorded on prescription charts Project 2: Promoting the safer use of injectable medicines Pre-filled syringes for high risk medicines: nursing time released to care Risk assessments to reduce errors with injectables: collaborative procurement What have we achieved? All trusts now use this data as a measure of quality & safety South Central

Project Plan Project 3: NSAID related harm Baseline audit completed. Usage data reported 3 monthly, preparation for monthly prescription metric Project 4: Reduction of harm from omitted and delayed medicines in hospital Baseline audit for antibiotics completed. Single Trust audit for all drugs / doses completed. Preparation for monthly metric Project 5: Reduce the number of errors and harms with insulin Baseline audits completed. Preparation for monthly metric Project 6: Standardised accessible Medicines Management Training E-learning modules for all aspects of the medicines trail, for all professions. What have we achieved? All trusts now use this data as a measure of quality & safety South Central

Metric 2: Medicines Reconciliation Implementation of 7 Day Working Target line Implementation of Green Bag Scheme Staff vacancies NHS Isle of Wight South Central

Green Bag Scheme £20,000 Pump Prime PSF Medicines reconciliation supporting the safe transfer of patient’s medicines between care settings QIPP and Waste Campaign Recent audit in South Central: estimated saving of approx. £10 per patient admitted- from admissions data this equates to potential savings of £3.6million A further £1.26m from MR safety cost- avoidance for 70% of these patients South Central

Medicines Reconciliation Percentage of Meds Rec Completed (since 01 Apr 2011) %

Medicines Reconciliation Acute Trusts in FY 2011 %

Medicines Reconciliation Costs Avoided Further Cost Avoidances

Isle of Wight Example Cost avoidance Min Avg Max Med Rec 5 10 1. Estimated cost avoidance from medicines reconciliation within 24 hours of patient arrival (per patient). 2. HES data admission figures for 2010/11 and calculated uplift (3%) for 2011/12. Trust (HES title) 2010/11 2011/12 Month average 5QT Isle of Wight NHS PCT 25911 26688 2224 3. Actual data collated by Trust – used to calculate % achieved Trust IoW Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Adult patients sampled 208 211 194 215 196 204 173 164 150 175 156 161 124 180 137 179 185 Med Rec completed 67 92 125 139 120 111 99 73 93 104 112 103 77 109 117 % Med Rec   32% 44% 64% 65% 71% 59% 60% 49% 53% 67% 70% 75% 57% 56% 61% 63% 4. Calculated avoidable and avoided costs (monthly average from 2 applied to % achieved from 3) Trust IoW Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 HES adult admission 2224 % Med Rec 32% 44% 64% 65% 71% 59% 60% 49% 53% 67% 70% 75% 57% 56% 61% 63% Avoidable cost 7538 6272 3955 3931 3234 4579 3985 4407 5708 5211 3707 3384 2780 4757 4870 4349 4087 Costs avoided 3582 4849 7165 7189 7886 6541 7135 6713 5412 5910 7413 7736 8340 6363 6250 6771 7033 Therefore, using IoW data for 2011 : £5 cost avoidance per patient x 26688 admissions = £113,340 total Average of 61% medicines reconciliation achieved = £69,137 in cost avoidance achieved with 39% further potential savings = £44,203 in avoidable costs

Dashboard South Central

Safer Use of Injectable Medicines Focus on practical implementation of targeted products identified by NPSA alert 20: Dobutamine 250mg in 50ml vial Morphine 1mg/ml & 2mg/ml – 50ml vial Human soluble insulin 50 units in 50ml pre-filled syringe Four work streams were funded by PSF : Injectables: purchasing for safety Assessing risk to operators from exposure to hazardous injectable medicines Neonatal Injectables Medicine package inserts South Central

OUTCOMES Less delay to start administration for emergency injections (Magnesium for eclampsia- 0.5h) Ensure correct concentration (ward based preparation >10% out; Wheeler et al, 2008) Reduced waste Reduced rework (e.g. inadequate labelling) Less risk of contamination Eliminate human error Standardise concentration (ICS standards) Health & safety (needlestick injury, RSI) Assistance with assurance (NHSLA, NPSA alerts)

QIPP OUTCOMES…£261k over 3 years Cost of medicines: Adenosine for cardiac cath labs (save £10k pa) Morphine for PCA and continuous infusion (save £4k pa) Suxamethonium and thiopentone for emergency caesarean section (also eliminate unsafe practice – save £3.5k pa) Noradrenaline PFS – no UK instructions in ampoule pack NHS manufacturing units tender Process improved: 1,667 minutes nurses time per month released by introducing ready to use potassium syringes in adult critical care (approx. 20% band 5 = £5k)

IN PROGRESS Established current use of NSAIDs and are developing metrics and methodology for QIPP Medicines management e learning project published on Nelm Missed doses in process of audit and analysis for potential for metrics Number admissions hypoglycaemia evaluated for frequency and cost. Insulin in hospital. To identify areas for improvement and metrics Injectables in the community Dashboard South Central

Challenges Linking quality with safety to tangible savings Engaging with other professions Moving forward to kpi’s and standards for safety Communication, continuity and commitment Dashboard South Central

‘Reducing Needless Medication Errors Workstream’ For more information on the ‘Reducing Needless Medication Errors Workstream’ please see the Patient Safety Federation website www.patientsafetyfederation.uk or contact Fiona Eccleston- Project Manager Fiona.eccleston@iow.nhs.uk South Central