Short report: Collaborating for the Improvement of Medication Safety

On 18 November, the Meds Club Community – a community of users of the Better Meds electronic prescribing and medication management system, hosted an international event to talk about improvements in medication management. Topics addressed included: 

• Insight on the current state of clinical decision support systems for antimicrobial stewardship 
• Recommendations for stronger collaboration with patients when creating medication reconciliation 
• Best practices in closed-loop medication management 
• An overview of the state of medication digitalization efforts in the UK, shared by NHSX. 

SEE THE RECORDINGS 

Philip Scott, Reader in Health Informatics, School of Computing, University of Portsmouth, talked about progress made in decision support systems (CDS) for antimicrobial stewardship (AMS). As he mentioned, clinical decision support for AMS is associated with increased guideline compliance. However, the evidence base for CDS for AMS is not high quality. Scott continued by presenting an NHS randomised controlled trial which he is helping to conduct. The study aims to measure the impact of a decision-support application for prescribers.

Good Collaboration with Patients Can Aid Treatment Outcomes 

Lex Moon, a Clinical Services Pharmacist at Oxford Health NHS Foundation Trust, shared her insight into easing medication reconciliation in the mental health setting with better patient collaboration. Patients are often the most up-to-date resource about their medication. Establishing trust at the beginning of admission would make it easier to make and discuss challenges later in the patient journey. With established trust, patients also are more likely to ask more questions about their treatment and feel more involved in their admission and treatment decisions. This collaboration can have a strong impact on medication adherence and treatment in the future. 

Closed Loop Medication Management Challenges 

 Claire Tolliday, Interim CNIO and eHospital Senior Team Leader, and Patrick J. Lynch, Chief Pharmacist Information Officer (CPIO) from Cambridge University Hospitals NHS Foundation Trust, spoke about their experiences with closed-loop medication management.  

The international evidence is clear that using bar codes when administering medications reduces the overall rate of adverse drug events. The technology decreases transcription errors, thus improving patient safety by supporting nurses with the five rights of medication administration (right patient, right time, right medication, right dose, right route), said Claire Tolliday. What needs to be emphasized in implementing these systems is that technology does not replace the clinical judgment from the users; it can only aid it.

The introduction of barcoding is a transformational process in any hospital. End-users need to share the vision of the digital team, making close collaboration with the end-users essential. The Coded Medication Database in CUH now includes 80,000 drug codes and 55,000 barcodes, dm+d compliant, mentioned Patrick J. Lynch.  

The introduction of a closed-loop system brings various challenges, such as the bar codes being outdated and needing to be reported to the manufacturer, potential medications brought by patients not containing barcodes, medication in clinical trials need to be managed, and many other scenarios. During the implementation at CUH, some of the essential things included mapping the ward layout and workflow, confirming hardware, providing training and support, addressing compliance issues, and more, Patrick J. Lynch also mentioned. 

For more details, see the entire recording.   

Workshops!

The event also included four workshops on four different topics. 

What is most important: design and usability, or the spectrum of functionalities covered?  

Božidarka Radović, Better Meds Product Lead & Patrik Bevec, Design Lead for Clinical Applications, led the group discussing What is most important: design and usability, or the spectrum of functionalities covered?  The conclusion was that a good user experience and good design will attract new users and should be in focus above adding functionalities. If the user experience is poor, it can lead to clinical risks. 

Expected Benefits of ePMA systems 

Another group, moderated by Donna Smart, ePMA Senior Nurse at Dartford and Gravesham NHS Trust, talked about benefits expected in the future of medication digitalization. Participants from hospitals with different ePMA systems shared expectations about a smooth and robust transition in the discharge process. They expressed hope that the future will bring an integrated medication record, including information from the community. They also expressed an expectation for all medications to be available for prescribing in ePMA, regardless of their complexity of prescribing.

What have we learned from the data gathered with ePMA

In the group What have we learned from the data gathered with ePMA, moderated by Chiméne Morgan, Pharmacy Technician at University Hospitals Plymouth NHS Trust, the discussion centered around how to track IV to oral switches in antimicrobials. Participants also discussed challenges with allergies in ePMA systems and how to track if alerts actually changed prescribing of medications. 

How do you manage training complacency after ePMA updates? 

Christine Wadsworth, Clinical Lead at Better UK, moderated the group. How do you manage training complacency after ePMA updates? At trainings, people more often than not try to get to the end as soon as possible. They don't mind if they don't understand everything in the learning materials. Drawing a parallel with the everyday world – people generally don't read product updates but work them out on the way. The problem with upgrades is that users adopt bad habits and workarounds, and sometimes upgrades don't allow them to do the workarounds anymore. One potential option would be to organize a refresher course and additionally make clear the connection between the right use of the system and clinical safety. It is also vital for the ePMA team to track if the champion users in different wards are still working for the hospital or have moved somewhere else in their careers.

Duncan Cripps, Lead ePMA Clinical Pharmacist, who held the role of the expert commentator throughout the event, also commented that "whenever there is a problem, people either want more training or alerts. The problem is that neither is very effective since users are already struggling to find the time to do the core training." As he added, support in the form of shadowing and observation of work on wards and delivering support on the spot is one of the possible approaches for improved use of systems.

How can national digital medicines work to support frontline services? 

Chris O'Brien, Programme Manager for Digital Medicines, and Ann Slee, Associate CCIO (Medicines) at NHSX talked about the importance of medicine standards and their role in patient safety. Too much time is lost due to sourcing, transcribing, and passing information between systems. Another impact digital systems could have is a reduction in overprescribing. In 2010 it was estimated that 300 million British Pounds of prescribed medicines in the NHS are wasted each year. The volume of prescribing is increasing in primary and secondary care, directly affecting patients. “Currently, around 15% of people in England take five or more medicines, 7% take eight or more. Adverse drug reactions risk is increased and can lead to patient harm. It is estimated that at least 10% of the current volume of medicines may be overprescribed,” said Ann Slee.  

Chris O'Brien presented what has been done already to curb these issues and what are the improvement plans for the future. By the end of March 2023, new common standards to support the transfer of medicines information between settings, enabling safer and more efficient medicines reconciliation, will need to be used across healthcare settings.  

All Trusts are invited to share their learning through Masterclasses, take part in hackathons organised by INTEROpen. In addition, anyone can send an email to interoperablemeds@nhs.net for general inquiries.