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Reducing omitted and delayed doses

Wasim Baqir, research and development pharmacist at Northumbria Healthcare NHS Foundation Trust, explained that there are many reasons why medicines are missed on wards.

By newsteam

Reducing unacceptable omitted doses: pharmacy assistant supported medicine administration Wasim Baqir, research and development pharmacist, and the Omitted Dose Project team at Northumbria Healthcare NHS Foundation Trust, and William Horsley, postgraduate doctoral researcher, Durham University et al


In 2007 the National Patient Safety Agency revealed that the second largest cause of medication incidents reported was omitted and delayed medicines, which sometimes resulted in serious consequences. Work in Northumbria has shown that pharmacy assistants can be trained to support nurses on medicine rounds, reducing the unacceptable missed dose rate from 18.5 per cent on the control ward to 1.1 per cent on the intervention ward.

Wasim Baqir, research and development pharmacist at Northumbria Healthcare NHS Foundation Trust, explained that there are many reasons why medicines are missed on wards. Examples include the nurse getting called away during the administration process, a medicine not being in stock on the ward and pack changes so that the nurse does not recognise the medicine. He added that although most missed doses are not a problem, there is a critical list of medicines for which missed doses could result in severe harm or death. This includes anti-infectives, anticoagulants, resuscitation medicines, insulin, cardiovascular medicines, antiplatelets and immunoglobulin. At Dr Baqir’s trust, pharmacy assistants accompanied nurses, double checking medicines, sourcing medicines not readily available and reminding them to countersign the patient treatment chart. Charts were evaluated over two weeks, showing that one in five patients missed a dose when medicines were administered by nurses alone compared with one in 100 when supported by a pharmacy assistant. “The results were better than expected,” Dr Baqir said. He told The Journal that although initially the nurses were “a bit apprehensive”, as the pilot progressed, they highly valued the teamwork.

It costs to add more staff into systems, but Dr Baqir believes that if using assistants to support administration increases quality, savings will be made overall. He said that the results of the pilot were so powerful that his trust is keeping the practice going — although there are not enough pharmacy assistants to put on every ward, the trust is using its data to implement the system on its highest risk wards. The next step will be to measure behavioural change — to see if omissions increase when the pharmacy assistant is taken out of the ward, Dr Baqir said.

[David Campbell, chief pharmacist at the trust, spoke on behalf of the team at the awards.]

Citation: The Pharmaceutical Journal URI: 11103769

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