Although the current situation in healthcare is turbulent – with constant pressure to reduce costs and improve efficiency – the focus on patient safety remains and there are opportunities for progressive services
BSc MSc PhD FRPharmS
In England the Government has recently announced a wide-ranging reorganisation of health and social care services. The NHS white paper entitled, ‘Equity and excellence: Liberating the NHS’, emphasises the central importance of ‘continuing to protect and improve patient safety’ – and this is good news for pharmacy. Although pharmacists are often drawn into cost-saving initiatives, this should not be the only focus of activity; they should never lose sight of their responsibility to ensure that medicines are used safely and that patients are appropriately safeguarded in this respect. One report in this issue of HPE describes a valuable safety initiative. Medication safety pharmacist, Karin Start, reminds us of the problems and risks surrounding the use of flushing solutions for vascular access devices and describes how it was tackled in her hospital (see page 53). This seemingly straightforward procedure has been at the root of a number of incident reports – some fatal. Prefilled syringes of saline flush solution were introduced and staff were educated to use them correctly. A detailed table was also compiled to indicate the situations in which other types of flush solutions would be appropriate. Initiatives like this remind us of two things – first, even something as seemingly mundane as line-flushing can be fraught with danger in a busy ward environment and second, the pharmacy is the only department in the hospital that sees the whole picture of medicines’ use in the organisation and is in a position to lead on improvements.
Another aspect of reorganisation that has been grinding away in the background is the formation of the Care Quality Commission as the independent regulator of health and social services. It has set the standards to which all services should work in a document entitled, ‘Essential standards of quality and safety: Guidance about compliance’. Where its predecessor made only a blanket statement to the effect that medicines should be managed safely and effectively, this organisation has taken the opportunity to spell out in some detail what is expected. Not only does it outline the services and systems that need to be in place but it also described what the people who use the service can expect to experience. It clearly requires providers to manage risk through effective procedures for medicines’ handling. This includes the establishment of arrangements for reporting adverse events, adverse drug reactions, incidents, errors and near misses.
Although times are turbulent and many pharmacists will be painfully aware of the overriding drive to reduce costs in healthcare, times of change are always times of opportunity. The recent publications could provide a useful springboard for pharmacy services. Many hospital pharmacists have always felt that improving outcomes through the safe use of medicines lay at the core of their work – now there is official recognition for this and it is an opportunity that should not be missed.