Unannounced inspections of facilities providing hospital care for elderly patients in Wales have revealed serious shortfalls in medicines management, according to a new report
Spot visits were organised in response to the ‘Trusted to care’ report published in May 2014, which was critical of older people’s care at two hospitals in Wales. The inspections revealed shortcomings in the management of medicines in the vast majority of wards visited. The problems were mainly related to storage and inspectors said the issues had the potential to compromise patient safety.
Steps are being taken to address the concerns at the hospitals, and a working group with pharmacist input has been set up by the Welsh government to develop solutions.
The inspections were ordered by Mark Drakeford, Minister for Health and Social Services in Wales, who announced the findings at the 4th Annual Wales Medicines Safety Conference in Cardiff on 16 October 2014, organised by the Royal Pharmaceutical Society (RPS).
The spot checks were intended to give confidence to the public and patients that the problems identified in ‘Trusted to care’ were not systemic across Wales. Inspection teams, which included pharmacists, visited 70 wards across all 20 district hospitals in Wales between 15 June and 30 July 2014 to assess four aspects of elderly care: sedation, medication, continence care and hydration.
Problems with medicines management included medicines not being locked away, a lack of space to prepare them, and controlled drug cupboards not meeting required standards. Inspectors said there were no systemic concerns about patient hydration, continence needs or the use of sedation.
“The [‘Trusted to care’] report sent a shockwave through the NHS here in Wales,” said Drakeford. “The good news is, in three of the four areas examined, the things that had been identified in the ‘Trusting to care’ context were not to be found in an endemic sense in other parts of Wales.”
He said health boards had taken the issues identified by the spot checks seriously and showed evidence of improvement. In addition to setting up the working group, over 95% of hospital pharmacy staff have completed an e-learning programme on professionalism and attended practical workshops.
Inspection teams will conduct one further round of visits to assess standards in mental health units among older people with compromised mental capacity.
Mair Davies, chair of the RPS’s Welsh Pharmacy Board, said implementing the vision outlined in the ‘Your care, your medicines’ report into the future of pharmacy in Wales, announced ahead of the conference, would help to address problems highlighted by the spot checks.
Sarah Rochira, Older People’s Commissioner for Wales, said: “It is important that health boards across Wales are not complacent and continue to have an unrelenting focus on driving out poor care and ensuring that best practice, of which there is much across Wales, quickly becomes standard practice for all older people.”
 Welsh Government. Learning from Trusted to Care: Ministerial Unannounced Spot Check Visits. All Wales Report by the Welsh Government. Cardiff. Online 16 October 2014.