To consider a report of the Chief Executive, Wirral University Teaching Hospital in response to a request by the Committee in relation to Medicines Management.

The Committee considered the report of the Chief Executive, Wirral University Teaching Hospital in relation to Medicines Management in hospitals.

The report indicated that medicine management encompassed the entire way that medicines were selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines made to producing informed and desired outcomes of patient care.

In January 2012, a CQC (Care Quality Commission) report stated that there were moderate concerns with medicines storage at Wirral University Teaching Hospital in light of information received following an audit of storage across the Trust. The medicines storage facilities had been developed as part of the original hospital build in 1982 and, unlike in many more modern hospitals, there were not bespoke areas where medicines were selected and prepared on most wards.

In April 2012, the Trust received an unannounced CQC inspection. The rating was reduced to minor concerns following their visit during which they noted improvements in the storage of medicines as a result of both behavioural changes and a significant on-going programme of investment in storage facilities at ward level. They did observe issues with the way medicines were reconciled when patients were admitted to the Trust and an over reliance on the pharmacy service to ensure that this was completed properly (medicines reconciliation is the process by which a medicines history is taken and then the correct medicines are prescribed on admission). They also identified that the bedside lockers used to store patient medicines were not fit for purpose.

In September 2012 a further unannounced CQC inspection occurred. Following the inspection the Trust was found to be fully compliant with the medicines management standard.

Mr Allison indicated that a range of work has been undertaken to improve the way medicines were managed in the Trust. Over £500,000k had been invested to provide a medicines storage room on every ward with British regulation compliant medicines and controlled drug cupboards; over £150,000k had been invested in new bedside lockers to support medicines administration by nurses and self-administration by patients where appropriate; ward stock lists had been reviewed to separate medicines types and cupboards were organised and labelled alphabetically to support healthcare professionals to find the medicine they need. Pharmacy support staff now put away medicines on many of the Trust wards to release nurses to spend more time on patient care.

A programme of education relating to medicines storage was delivered to nursing and healthcare workers at ward level. Pharmacy support staff now undertook unannounced medicines spot checks and fridge temperatures were regularly monitored. Checklists were introduced for ward sisters and monthly matron spot checks occur, and the results were monitored at the Trust Governance Committee. A range of publicity materials were developed - newsletters, flyers, etc which highlighted key issues and actions required. 

In relation to Medicines Reconciliation, A lead consultant was nominated to champion medicines reconciliation; updated documentation was launched following feedback and an intensive period of education occurred at all junior doctor handover, to emphasise the importance of completing the paperwork appropriately. Medicines reconciliation was included in the junior doctor induction training. Additional pharmacy staff was placed on the admission area of the Trust to support prescribing. Pharmacy staff were now training 5th year medical students to undertake accurate medicines reconciliation.

Additional medicines management training were being delivered by pharmacy staff on a range of topics and a small pilot of self-medication was occurring and would be extended in 2013. Funding for a Medicines Management Nurse had been approved to provide support to the medicines management agenda and to support the roll-out of self-medication in the Trust. It was hoped that an appointment will be made early in 2013.The way medicines were being administered was under review, to promote the management of medicines at the bedside where the nursing staff can spend more time with patients as they administer medicines. The Pharmacy obtained a Wholesaler Dealer’s Licence in 2012; this allowed the Trust to supply medicines to other organisations but also provided assurance regarding the medicines procurement and distribution services in the Trust. A new clinical guidance website was in development which, once live, would provide additional support for prescribers in one easy to find location. A pharmacy prescription tracker had been developed to support effective and safe discharge. Pharmacy staffing at the weekend and out of hours has been reviewed to provide additional cover at these times. The Trust resuscitation boxes had been redesigned to ensure that fluids needed in this situation were secured within a box and not left loose on resuscitation trolleys. Some areas of work would require a change in electronic prescribing system utilised in the Trust. The prescribing element of the new Cerner Millennium system had been delayed and the Trust was currently reviewing its options in light of this delay.

The report concluded that the Trust had made significant progress with the way medicines were stored and handled, but was not complacent and had a programme of work on-going to further improve and extend good practice in line with its policies and procedures.

In response to Members, Mr Allison indicated that medicine given on discharge was still an issue with problems occurring during ward rounds and with different consultants with different working practices; however, this was something he would be looking at. In relation to patients taking own medication into hospital, non disclosure was a major concern, Mr Allison indicated that this would be written into the drug reconciliation programme and nursing staff would be expected to be vigilant and it was also reliant on the honesty of patients.

RESOLVED –

That the report on medicine management be noted and Mr Allison be thanked for his update.