We read with interest the interview with Professor Don Berwick (The Pharmaceutical Journal 2017;299;153–154) building on his report published in August 2013 ‘A promise to learn – a commitment to act: improving the safety of patients in England’.
In University Hospitals Leicester NHS Trust (UHL) pharmacy we have taken this to heart with our project piloting unit-dose medicines distribution using automation, electronic prescribing and barcode technology to link the patient, drug chart and medicine. We have undertaken this project in collaboration with the East Midlands Academic Health Science Network (EMAHSN) and would endorse Professor Berwick’s assertion that AHSNs are valuable in building collaborative work in areas of safety.
The unit dose project in Leicester has produced not only improvements in patient safety via a reduction in missed doses due to medicines not being available on wards (from 10% to 1.2%), but it has also resulted in reduced costs. These include a 25% reduction in the consumption (and costs) of medicines, a 55% reduction in the number of items held in ward stock cupboards, a 29% reduction in re-supply when stock items cannot be located and a 71% reduction in the value of medicines wastage.
A further safety advantage is the use of barcode technology to support unit dose supply and administration, thereby increasing the visibility of medicines logistics throughout the system and enabling the tracking and costing of medicine at a patient level. Professor Berwick in his interview makes the point that failure to track medicines use can adversely impact on patient safety albeit across primary and secondary care. The unit dose system we have piloted in UHL will also track medicines use as patients transfer between wards.
Using unit dose, the current burden caused by an under-resourced nursing team is also eased via simplified medicines rounds and medicines administration. This has created efficiencies that have been leveraged elsewhere across frontline nursing teams since nursing staff need less time for preparing medicines for administration and no longer chase unnecessary re-supply. There is also a reduced administrative burden on the pharmacy team through a reduction in time spent on medicines stock management thereby freeing up time to do more clinical-related activity.
Ward clinical teams have appreciated the certainty of location and availability of medicines, making medicines rounds easier for nursing staff. The automated supply reduces the risk of medicines administration errors, reducing stress among nursing staff and improving morale. Consequently, UHL nursing teams have strongly embraced deployment of the system through a more tidy, easy-to-work-in environment with faster, simpler medicines rounds.
We believe the above demonstrates Professor Berwick’s assertions that safer, higher quality care can reduce total costs of care. We would also add, from evidence in UHL, that it can improve staff morale and efficiency.
Graeme Hall Deputy Associate Chief Pharmacist / Chief Pharmacy Information Officer, University Hospitals Leicester NHS Trust
Chris Hart, Commercial Director, East Midlands Academic Health Science Network