Brian Edwards CBE
Emeritus Professor of Healthcare Development
University of Sheffield
Hospital pharmacy departments are increasingly automated. Many of them now have equipment that will dispense from stock standard packs of drugs for individual patients on the basis of a ward order. It is rather like a cigarette or chocolate dispenser, and it appears to work. What it does not solve is the threat to patient safety as a result of packaging that does not help the person giving the drug to discriminate between types of drug and dosage levels. Getting the wrong drug is one of the major causes of harm to patients. International research suggests that 10% of all hospital admissions suffer from an adverse event.
Electronic tracking of drugs when linked to a barcoded patient might help. However, the principal reason for tagging is to improve security and deal with the growing problem of counterfeit drugs. The WHO figures suggest that developing countries account for around 77% of all reported cases of counterfeit and substandard drugs, but the problem is growing in Europe and in particular in the new accession states. Despite its cost, electronic tagging should become standard in Europe.
These days, every international exhibition is full of wonderful new technology, and some of it really is impressive. The downside is multiple pieces of kit scattered throughout hospitals, which adds to safety problems. The other problem is poor equipment maintenance and obsolescence.
What we need are more industry-wide standards and specifications that add to safety but do not stifle progress and innovation. This is never an easy balance to strike. What we do not need is a new raft of European regulation that would require all who use medical equipment to have a certificate to show that they have been trained to use it. This is the responsibility of hospital and healthcare employers, but simple training aids produced by manufacturers would be useful. Pumps of all kinds seem to present particular problems because of the enormous variety of models available. It would not be unusual to find 15–20 different types in use in a typical hospital. Many hospitals are moving to reduce this range on the grounds of both safety and economics.
Drug information is in a lamentable state. Patients who read the cautions and warnings contained in medicine packs often decline to proceed … and with good reason. These leaflets are written to avoid legal liability rather than inform patients. It really is time for the industry to rethink its practices in this field. The internet contains much information, but reliability is a problem.
I think it is high time pharmacists took their role as expert patient advisors more seriously, including advice and counselling in the prescription dispensing process. Of course this means time and facilities for patient privacy, but patients would probably think it worth the modest increased costs involved.
As always, new technologies are both a blessing and a problem.