Acute care hospitals in England supply patient medicines using so-called one-stop dispensing (OSD), which combines medicines used while a patient is an inpatient with those given to take home. Dispensing once so the patient is ready for discharge seems logical. However, scratch the surface and problems emerge. In acute care, patients move wards frequently and medicines are often changed. As a result, patients miss doses, nursing time is misspent and wastage becomes an issue.
At the University Hospitals of Leicester NHS Trust, we are running a project to confirm the outcomes of an automated prescribing and dispensing system. The system, developed by our partners at Ingegneria Biomedica Santa Lucia, has delivered improvements over ten years in Italy. We hope these benefits can be replicated in UK hospitals.
The system uses modern robotics and IT software and, since it is modular and flexible, it allows hospitals to collaborate to spread investment costs.
Most NHS hospitals will be familiar with the problems of OSD. For example, part packs of medicines have to be stored or recycled after a change in medication; full packs of medicines have to be redispensed if lost; medication errors result from poor checking, poorly written drug charts and inaccurate prescribing; and nurses waste time looking for medicines drug charts.
With our new system, medicines are provided to inpatients at an individual dose level rather than patient pack, and medicines are delivered automatically into segregated, patient-specific drawers just before the medicines round with the help of electronic prescriptions. (Individual doses are used widely in the United States and mainland Europe.) A full closed-loop medication administration system is created where every medicine, patient and prescription would be coordinated using barcodes. This would reduce drug omissions and errors, and speed up drug rounds. Additionally, the whole system is connected to logistics software to enable stock and inventory management.
We are careful not to make assumptions about what works and therefore are doing research to gather evidence on how this system could improve the medicines supply process in our hospital. Evaluation is being carried out independently by Loughborough University funded by the East Midlands Academic Health Sciences Network, and we will find out the results of our pilot later in the year.
We encourage colleagues in other hospitals to consider the use of technology to improve medicines supply, supported by research and evaluation. Perhaps the NHS will discover that one-stop dispensing has had its day.
Tim Bourne, MBBS FRCA, consultant anaesthetist and associate medical director, University Hospitals of Leicester NHS Trust
Graeme Hall, MRPharmS, deputy chief pharmacist, University Hospitals of Leicester NHS Trust
Jeanette Halborg, RN, head of nursing clinical support and imaging, University Hospitals of Leicester NHS Trust