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Published on 2 November 2009

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Injecting clarity

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Surveys of the existing systems for preparation and administration of injectable medicines have revealed serious shortcomings and experts have called for innovative solutions to tackle the problems

Christine Clark

BSc MSc PhD FRPharmS
FCPP(Hon)
Editor
HPE

As every gardener knows, when you lift a stone you find all sorts of interesting things underneath-sometimes unexpected ones. This is just how our colleagues must have felt as they implemented the NPSA Alert (Promoting safer use of injectable medicines), for they progressively uncovered more and more alarming details of the existing ‘systems’ for preparation and administration of injectable medicines. On the face of it, the first task was straightforward, if onerous. It involved using the risk assessment tool provided to assess all injectable medicines in use and then finding ways to reduce the risks.

At a recent one-day meeting (see Braun report, page 14) expert speakers explained how a bigger picture had opened up. Careful surveys turned up several interesting and sometimes jarring pieces of information-often the type of thing that would make uncomfortable headlines. Furthermore, it seemed that at every turn there was another barrier or problem.
Here are the key points:

  • A not insignificant number of injectable products fell into the high-risk category- some were rarely-used items but many were frequently-used.
  • Local aseptic units prepared some products- but not all of the high-risk items were covered in this way. One obvious option was to make a wider range of products in local aseptic units, and perhaps some in licensed NHS manufacturing units.
  • When the numbers were calculated it quickly became apparent that there was a huge shortfall in capacity in local aseptic units accentuated by recruitment problems that make this sector chronically short of staff.
  • Maybe the industry should make more ready-to-use products, said the wise ones-but this was far from straightforward because, to put it baldly, the NHS could not make up its mind what it wanted. Surveys done by the Intensive Care Society and the Critical Care Pharmacists last year showed that for several commonly used drugs a vast range of different products -different concentrations and volumes- is routinely demanded and provided.

And thus it became clear that some more imaginative solutions would be required. Before this information had been researched and catalogued it was possible for many pharmacy services to turn a blind eye to the problem – however now that it has been investigated, counted and described in such detail it has become a very visible elephant in the room.

This situation provides an unparalleled opportunity for pharmacy services to shine. Successful resolution will require cooperation between clinical, technical and purchasing pharmacists. It also calls for cooperation with industry- several new aseptic compounding units are being set up, but if they are to be able to offer the best service to the NHS they will need predictable demands and standardised products. In the meantime the NHS will have to look at using its own resources more effectively and certainly the ProFile database should help people to make the ‘make or buy’ decision in a more informed way.

Martin Stephens, the hospital pharmacy Tsar, underlined the period of austerity that is facing the NHS and stressed the need for innovation to tackle these problems. Safety and quality should prevent waste and save money, he told the audience; it is good to know that the Department of Health understands this.

When NPSA Alert 2007/20 was launched we were told that intravenous medicines were a frequent subject of adverse drug event reports. At last we are beginning to see the shape of the vision behind the alert and the impact of working through the tasks that it imposed. It offers the prospect of making injectables safer for patients and in so doing raising the quality of care. It requires pharmaceutical expertise but also skills in leadership and collaboration. If the recent meeting was a reliable yardstick then hospital pharmacists are measuring up to the job and that is something of which pharmacy could be justly proud.



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