Patient safety is being compromised by poor medicines management in many NHS and adult social care services, finds a report by the Care Quality Commission (CQC), which inspects health and social care services in England.
The CQC’s annual State of Care report
, published on 15 October 2015, reveals that safety was inadequate at 13% of acute trusts, 10% of adult social care services, and 6% of GP practices and out-of-hours services inspected so far under its new regime.
A further 61% of hospital trusts, 33% of care and nursing homes and home care services, and 25% of GP services inspected require improvement, the CQC report says.
“The report shows the pressure our members are under during the toughest times of a generation and that variation still exists in care quality and delivery,” says Rob Webster, chief executive of the NHS Confederation.
Medicines management, staffing levels and the way mistakes are investigated all affect safety, the CQC found.
Examples of issues of “intense concern” at organisations rated inadequate for safety included medicines given without appropriate patient identification at a hospital and medication not administered properly at a care home, where some patients had their medicine delayed while others showed symptoms of overdose.
Medicines management was an issue raised as a concern even in acute trusts rated as good and outstanding. “There were still times when staffing levels and skill mix fell below the levels that trusts said they needed to properly care for the number of patients concerned and the severity of their conditions,” the report says.
“When this happened, a number of our inspection reports showed that risks to patient safety grew, and there were often more medication incidents.”
In general practice, CQC inspectors found a range of safety issues that indicated a lack of system and process, including poor storage of medicines, fridges at the wrong temperatures, and insufficient emergency drugs. Unsafe management of medicines placing patients at serious risk of harm was among the issues raised; medicines were found to be out of date, and requests for prescriptions had not been processed in a timely manner.
Inspectors also raised concerns about the storage and date of medicines at adult social care services, and found evidence of medicines not being administered properly.
Nadra Ahmed, chairman of the National Care Association, an organisation representing care providers, says care homes understand the importance of appropriate training and education in medicines management.
“I think the challenge we have is the relationships between GPs, pharmacists and the care homes. In the day when you had a local pharmacist in a local town that knew everybody and dealt with the care home on a specific basis, relationships were much stronger,” she says. “We now have the larger corporate pharmacy organisations supporting us and so it’s just viewed as a task.”
Ahmed would like to see pharmacists get more involved in assisting care homes with medicines management and training. While care home staff received generic medicines training, they had little understanding on what drugs were for and how best to administer them, she explains.
“When I was running a care home, every time a new drug was prescribed the local pharmacist used to give me a little fact sheet about what that drug did and what to look out for, which was really useful for our staff to be able to see,” she adds.
The State of Care data cover the first 14 months of the CQC’s new inspection programme, which was launched in April 2014. So far, the CQC has inspected nearly half of acute hospital trusts, 17% of adult care services and 11% of GP surgeries and out-of-hours providers. Organisations that have high levels of risk have been targeted first.
 Care Quality Commission. The state of health care and adult social care in England. October 2015.