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

Medication Errors do happen.. 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 effects 1 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 South Central 1.Pharmacy in England Building on strengths – delivering the future, Department of Health NICE/NPSA patient safety guidance to improve medicines reconciliation at hospital admission. National Patient Safety Agency. December available from http/

Project Plan Project 1: Metrics: 3 rd 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 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. South Central

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

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

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

Acute Trusts in FY 2011 %

South Central

Green Bag & Medicines Reconciliation South Central Input Green Bags £20k Output /delivered Across SCSHA* £3.6m savings from medicines £1.26m safety cost avoidance Supports SC QIPP waste medicines campaign Green bags & metrics being adopted nationally *estimates of savings to secondary care (J.Hough) NPSA /NICE

South Central Safer Use of Injectable Medicines Dobutamine 250mg in 50ml vial Morphine 1mg/ml & 2mg/ml – 50ml vial Human soluble insulin 50 units in 50ml pre-filled syringe Focus on practical implementation of targeted products identified by NPSA alert 20: 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

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)

South Central Injectable Projects 3 year project South Central Input £152k (4 workstreams) Output /delivered Risk assessment template for high risk injectable medicines Risk assessment of ward based injectable medicines Purchasing for safety policy – prefilled syringes (insulin, dobutamine, morphine) £261k savings in consortium purchasing and released nurse time, (unquantified error reduction impact) Review and standardisation of neonatal infusion practice NPSA Alert 20 – ‘Promoting the safer use of injectable medicines’

South Central 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

Medicines Management Training Project South Central Input £15k 1st phase – scoping exercise (2 nd phase £30k – roll out) Output /delivered NHLSA Level 2-4 mandatory training ( % savings on insurance costs) CQC mandatory Identified gaps Produced index of learning resources online published on Nelm

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

South Central For more information on the ‘Reducing Needless Medication Errors Workstream’ please see the Patient Safety Federation website or contact Fiona Eccleston- Project Manager