Background
Methods
Results
Overview
Trust characteristic | Respondents (n = 100 trusts) | Non-respondents* (n = 65 trusts) | Statistical analysis |
---|---|---|---|
Median number of acute hospitals in trust (range) | 1 (1–5) | 1 (1–5) | p = 0.08; Mann–Whitney test |
Median number of wards at main acute hospital (range) | 25 (3 – 60) | 23 (1–44) | p = 0.12; Mann–Whitney test |
Services provided by main acute hospital | Adults (13) or paediatrics (1) only: 14 (14%) | Adults (2) or paediatrics (3) only: 5 (8%) | p = 0.21; Chi-square test |
Mixed: 86 (86%) | Mixed: 60 (92%) |
Systems and processes | Number of respondent hospitals (% of usable responses) |
---|---|
Prescribing and administration record |
■ Paper versus electronic prescribing system
|
87 (87%) used paper drug charts | |
13 (13%) used an EPMA system | |
Medication ordering and supply |
■ Methods used to order medications during pharmacy opening hours†:
|
59 (62%) via the ward pharmacy technician (during their ward visit) | |
55 (58%) via the ward pharmacist (during their ward visit) | |
26 (29%) via the ward pharmacist (outside of their ward visit) | |
24 (26%) by taking drug charts to the pharmacy | |
12 (13%) by computer/electronically | |
5 (5%) selected ‘other’: ‘pneumatic tubes’ (n = 2), “pharmacy teams are ward based” (1), “bleeping [paging] the sweep pharmacist [designated to order medication across a range of wards] in the afternoon” (1), “nurse ordering” (1). | |
■ Methods used to obtain medications outside pharmacy opening hours†:
| |
97 (97%) borrowed medicines from another ward | |
96 (96%) contacted the on-call pharmacist | |
89 (89%) used a non-electronic reserve drug cupboard | |
39 (39%) borrowed from another patient’s hospital supply (on the same ward) | |
11 (11%) used an electronic reserve drug cupboard | |
9 (9%) selected ‘other’: asked the family to bring in PODs (n = 5), accessed a dispensing robot via the on-call pharmacist (2), medicines were not generally ordered outside of hours (1), 24-hour pharmacy (1). | |
■ Types of medication supply for inpatient administration†:
| |
89 (94%) used ward stock | |
85 (89%) used PODs | |
82 (85%) used OSD supplies from the hospital pharmacy | |
46 (50%) used non-OSD supplies from the hospital pharmacy | |
3 (3%) selected ‘other’: all referred to the use of pre-labelled packs | |
Ward-based medication storage and transport during nurses’ drug rounds | |
91 (92%) used patient bedside medication lockers | |
55 (59%) used drug trolleys | |
■ Medication transport during drug rounds†:
| |
64 (65%) used drug trolleys | |
31 (43%) used medicines cup/oral syringe | |
10 (14%) used a tray/basket | |
6 (8%) used a temporary trolley (for example, dressing trolley) | |
2 (2%) selected ‘other’: 1 used “PRN lockers per bay”, 1 “drugs cupboard in [each] 6-bedded bay” | |
Medication administration processes, policies and guidance |
■ Regularly scheduled drug rounds (99; 100%)
|
■ Availability of policies and guidance:
| |
97 (98%) had an ‘out of hours access to medications’ guidance document | |
95 (97%) had guidance document on what to do if a drug was not available | |
90 (93%) had a ‘patient self-administration’ policy | |
80 (92%) had a ‘nil-by-mouth’ policy | |
98 (99%) had an IV guide: 71 (73%) paper-based version, 81 (82%) electronic |
Prescribing and medication administration records
Medication ordering and supply (including pharmacy services)
Ward-based medication storage and transport during nurses’ drug rounds
Medication administration processes, policies, and guidance
Drug name/group | No of respondent hospitals (%) |
---|---|
Double checking of specific drugs required but names of drugs not provided | 27 (42) |
Insulin | 16 (25) |
Heparin | 7 (11) |
Complex preparations | 6 (9) |
Potassium | 5 (8) |
Epidurals | 3 (5) |
Infusion devices | 2 (3) |
Oral methotrexate | 2 (3) |
Saline [sodium chloride 0.9%] flushes | 2 (3) |
Therapeutic doses of low molecular weight heparins | 2 (3) |
Clinical trial drugs | 2 (3) |
“High risk” [unspecified] intravenous drugs | 1 (2) |
Intravenous immunoglobulin | 1 (2) |
Midazolam | 1 (2) |
Paediatric doses requiring calculations | 1 (2) |
Local medication safety improvement initiatives
Local initiative | Number of hospitals | Examples |
---|---|---|
Extensive ward pharmacy technician and/or ward pharmacy assistant service | 10 | Technician discharge transcribing service |
Trial of technician medication administration | ||
Near-patient dispensing | 9 | Use of mobile dispensing units, satellite dispensary, and pre-labelled packs |
Extended pharmacy services to wards | 7 | Increased frequency of ward pharmacy visits, increased pharmacy opening hours, and provision of pharmacy service to wards on weekends |
Use of OSD and PODs | 6 | |
Self-administration schemes | 4 | Specific self-administration scheme for patients with Parkinson’s disease and separately for maternity units, and an ‘opt-out’ patient self-administration scheme |
Technology | 3 | EPMA, automated medication storage cabinets (for example, Omnicell®), an electronic discharge prescribing system, and an electronic prescription tracking system |
Quarterly medication storage review on wards | 2 | |
Other | 8 | Director/matron walkabouts with medicines checks on wards to identify potential medication problems and provide immediate feedback to ward staff, fast-track medication request system, pneumatic tube system, non-OSD supplies being additionally labelled with “inpatient supply only” to remind staff not to issue these to patients on discharge, standard operating procedures for nurses on specific administration processes, target turnaround times for inpatient supply, and changed order of tasks during drug administrations with IVs administered first followed by medicines on a critical list then other non-IV medications. |