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'Care home safety must not play second fiddle to the acute sector'

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A renewed focus on medicines management in care homes is needed, says the NPSA’s Bruce Warner

A recent news story in Nursing Times highlighted a study that found nine out of 10 care home residents are regularly exposed to medicine administration errors, half of which are deemed serious mistakes (news, page 6, 24 January). A major cause of these errors was cited by both researchers and care home staff as lack of time and interruptions during rounds, rather than lack of training. Other studies, such as the Department of Health commissioned Care Home Use of Medicines Study, have identified similar findings.

The most common error identified related to medicines being given at the wrong time. This is supported by data from the National Patient Safety Agency’s National Reporting and Learning System - it consistently shows omitted or delayed medicines are a major problem in all healthcare settings and that medication incidents account for nearly 10% of all patient safety incidents reported in England and Wales. With an ageing population taking increasing numbers of complex medicines, it has never been more important to ensure all healthcare sectors, including care homes, review the way they do things to make medicines use as safe as possible.

“Perhaps what’s needed is a more radical approach employing a complete systems redesign and the use of technology”

As a renewed focus on safety in care homes is due, following their registration with the Care Quality Commission, perhaps now is the time to look more fundamentally at the systems employed, and try and benefit from the lessons starting to emerge from other sectors. For too long, care homes have played second fiddle to the acute sector in terms of the focus they deserve on getting medicines management right.

Several different approaches have been taken to try and mitigate against the risk of staff being interrupted or distracted during medicines rounds, but is this just “tinkering” at the edges of the problem? Perhaps what’s needed is a more radical approach employing a complete systems redesign and the use of technology. There is now research in the UK to indicate that system redesign and the use of barcode technology can significantly reduce medication errors in care homes.

Research shows how technology can be used. This includes a handheld device that holds data on the care home resident - during a medication round, the user scans the barcode identifier to access a resident’s drug file; system checks then ensure the correct resident is getting the right medication at the right time. The device checks that the dose and quantity are correct and the medicine in date.

Such technology is already being used in pharmacies and is starting to be seen on hospital wards. Use of such barcode medication management systems, designed for care homes, can help avert a significant number of medication administration errors - and so far there is no evidence care staff adopt unsafe workaround practices, as is often the fear. An additional advantage of these systems is improved stock control and subsequent reduced costs.

This concept should be adopted as the gold standard for medicines management in the care home environment, and care homes should be positively encouraged to reflect on their processes and implement technology where it is available to them.

Of course this approach can only be successful with appropriate support from the multidisciplinary team responsible for the patient’s care, care commissioners and those providing medicines support such as community pharmacies and specialist companies. Radical changes now happening within the NHS and the social care sector may provide the right platform for these changes to take place - perhaps the time is now right for a renewed and energised focus in this area.

Bruce Warner is associate director of patient safety at the National Patient Safety Agency

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