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'Pharmacy needs adequate funding to tackle medication errors'

Jeremy Meader: Many medication errors are avoided by the intervention of a community pharmacist

Health secretary Jeremy Hunt will only successfully reduce medication errors if the sector has the funding to ease pressure and improve patient care, says Numark's Jeremy Meader

When a dispensing error causes catastrophic harm or even death, there’s no getting away from the devastation caused to patients and their families, and to pharmacists, their teams and their professional reputation and standing. The fall out is significant and far-reaching.

The cases of pharmacists Elizabeth Lee and more recently Martin White – who was given a four-month suspended sentence for inadvertently causing the death of his patient – hit the world of pharmacy hard and made the headlines.

Decriminalisation of dispensing errors has been an ongoing debate for many years. As the pharmacy profession continues to deal with increasing pressures, health and social care secretary Jeremy Hunt’s intention to introduce "ground-breaking" new measures to reduce harm caused by medication errors is an important step.

It will protect not only patients, but pharmacists – who continually battle with the complex clinical care of patients, many of whom are living longer and need an increasing level of support with their medicines.

At a recent patient safety summit, Mr Hunt described the following government measures designed to address medication errors:

  • Creating new systems linking prescribing data in primary care to hospital admissions
  • Accelerating the introduction of electronic prescribing systems across more NHS hospitals
  • A legal defence for pharmacists if they make accidental medication errors rather than being prosecuted for genuine mistakes.

Mr Hunt’s announcement followed the publication of a report by researchers at the universities of Sheffield, York and Manchester. I found some of the statistics in the report staggering:

  • Of the 237 million medication errors that occur in the UK each year, 72% are classed as minor (with little or no potential for clinical harm), but 26% and 2% of errors have the potential to cause moderate and severe harm, respectively
  • There are 66 million potentially clinically significant errors every year, and 71% of these are in primary care
  • The estimated cost to the NHS of "definitely avoidable" adverse drug reaction (ADRs) is £98.5m a year
  • Prescribing constitutes 21% of errors, and 50% and 2% have the potential to cause moderate or severe harm, respectively.
The sector's responsibilities 

So the problem is really big. As I read the report with increasing despair at the number of patients at risk of significant harm and death in primary and secondary care and care homes, a quote from the American broadcast journalist Daryn Kagan sprang to mind: “Bad things happen in the world, like war, natural disasters, and disease. But out of those situations always arise stories of ordinary people doing extraordinary things.”

The quote made me think of community pharmacy, where ordinary people do extraordinary things. Like dealing day in, day out, with people with chronic and complex medical conditions, and dealing with challenging patients from all walks of life when they are desperate, frustrated, in pain and in need. 

What a huge responsibility we have to not only reduce the harm caused by errors but to treat, advise, protect, and sympathise with our patients.

And what a fantastic job we are doing: dispensing errors account for just 16% of total errors, with 1% of the cases having the potential to cause severe harm. While not lauding these statistics, we should not be ignorant of just how many more errors are avoided by an intervention from a pharmacist.

Mr Hunt’s intention to impose a new legal defence as soon as April is an important step forward in bridging the gap in patient care. This must be achieved to not only protect patients, but also to protect pharmacists and ensure that an inadvertent dispensing error is treated as such – an error which is no longer criminally prosecutable.

Improved access and shared data between prescribers and pharmacies will no doubt also help, but we must get to the root of the issue, which – whether Mr Hunt agrees or not – has to come down to adequate funding to ease the pressure pharmacy is under. Only then can patient care be effectively and proactively managed to deliver the results Mr Hunt is so keen to see.

Isn’t it about time we are recognised, supported and remunerated appropriately for doing the extraordinary every single day? 

Jeremy Meader is managing director of the pharmacy support group Numark

20 Comments

Gareth Rowe, Community pharmacist

I have to say I am bemused by some of the comments. There is absolutely a funding problem in pharmacy that directly affects staff levels. In England some contractors are struggling to pay their wholesaler bills each month! If that continues they surely can't invest in staff. Prescription numbers continue to rise which only adds to the pressure. It doesn't matter if it's March or Christmas week, the more you dispense then statistically you are more likely to make an error. To conteract that you need more hands to share the workload. Of course some may cope with pressure better than others but it doesn't mean they are inept and should be kicked out of the profession, especially if that pressure is partly caused by lack of funding leading to under staffing!

Hub and spoke has been shown in many ways to not to be the great solution that it has been hailed. How many times do we sort out medication for people who have run out etc. If the script has gone to a hub how does that work? 

That we are not being seen as an integral part of the NHS is a failure of our negotiating bodies and something they should be rectifying. We keep people out of GP surgeries, away from Out of Hours services and away from A&E by going above and beyond. Someone needs to be explaining this forcfully to Mr Hunt. If we all audited just how much work we do (for no remuneration) that stops people having access the above services and it could be presented to the DoH maybe we could go some way to showing them our worth and how much we save the NHS.

We walk in to work in the snow (GPs didn't) and walk deliveries out, come in early and go home late to get the job done. If you are not having to do these things then you are lucky, but as a profession we need this to be promoted at a time when we are under threat and we need to stick together on it. In Wales Welsh Government have recognised our value much more which is to be appreciated, but we are still having to do more to achieve something like the same level of remuneration as previously and as we are part of an England and Wales Drug Tariff there is only so much they can do. Community Pharmacy Wales are working hard with them reinforcing our value and trying to get new services introduced to maintain our income stream but of course to do these we need adequate support staff so we come back to the initial topic.

So well done Jeremy for highlighting this, Sadly, with the current regimes of both our DoH ministers and our negotiating bodies,  I don't initially expect much to change. However, the more these messages get out the better. And the more we support communications like this the better too

Jonny Johal, Pharmacy Area manager/ Operations Manager

Gareth, "We walk in to work in the snow (GPs didn't) and walk deliveries out, come in early and go home late to get the job done" I applaud you. My only comment is I know very few pharmacists who do that (I mainly work in the employed sector), Sadly, I have seen, especially in recent years, pharmacists who want the money, the title but not the work. The work-shy pharmacists I came across usually enjoy talking very much, and they leave issues behind for other pharmacists to sort, refused to help stock-takers because they don't consider that 'professional duty', they don't put deliveries away (but when they make a dispensing error, they blame the staff for putting the items in the wrong locations, and don't think they have a duty to read the drug names), they double up when they work with locums so they can do 'paperwork', they are always looking for excuses to give prescriptions back to patients and use terms like 'refer to prescriber' (they don't like ringing the docters to sort issues because that involve work on their part), a pharmacist manager once explained to me that he only print labels off, he doesn't think dispensing is his job unless the patient have returned and present in the pharmacy before the end of his shift etc etc ...... need I carry on? I am certain that most of us are aware of such a sub-population amongst our midst.

A B, Community pharmacist

If there were legislation for minimum staff levels in a pharmacy it would make the dispensing error debate more simple.

It is hard to prove errors occur as a result of low staff numbers. High profile error cases highlighted by the recent Boots programme on BBC showed no link to staff levels. I'm guessing there is a lot of under reporting of errors, errors which may have been down to staffing levels but we'll never know. 

Throwing money at the problem won't fix it unless there is legislation to back it up to make sure the money goes on staff numbers. If a pharmacy is adequately staffed it should (I know it's a big should) mean the pharmacist has more time to deliver services and check scripts if there is no ACT.

Jonny Johal, Pharmacy Area manager/ Operations Manager

AB, the Boots cases demonstrate that staffing levels may not be the cause of errors. As I said previously, my personal experience with errors would lead me to believe that the quality of pharmacists may play a part most of the ones I came across. A simple linear relationship between stress and errors or staffing and errors have yet to be proven. 

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

I agree that legislation appears to be the best way forward in tackling both pressure and error reduction. To start, an open source statistical analysis into time management within a pharmacy will be most illuminating and from that we can mathematically work out how much staffing time is required in a branch based on item numbers even it's it roughest form.

A B, Community pharmacist

I think most of the multiples have a formula for this already. If Boots agree to share their formula along with the others, maybe this could be used as a template. I could see a government backed analysis (if it ever happened) taking years and costing a lot of money.

Gareth Rowe, Community pharmacist

I'm not sure the Boots model works very well as they have been subject to some errors which the programme highlighted were influenced by staffing pressures. 

Jonny Johal, Pharmacy Area manager/ Operations Manager

The BBC progarmme did conflate the 2 issues of staffing concerns and errors, but then the programme also made it clear that the high profiles cases featured were not caused by poor staffing levels.

Graham Pharmacist, Senior Management

I think Mr Meader has it in a nutshell. And good for him for saying it! At least Jeremy seems to be thinking about the bigger picture.

Pharmacists always go over and above the call of duty during times of crisis, but as he states in his last sentence, they should be remunerated for this. Pharmacists are not remunerated correctly for the service they provide. Pharmacists earn less than people who buy fast-food franchises and corner shops. In London you can earn 400 quid a day driving a taxi. That says it all about this profession really.

I cannot even to begin to think how I would feel if I killed a patient via dispensing error because of workplace pressure. It would at least be the end of my pharmacy career and possibly my life. The guilt would haunt me forever.

Does nobody really have the ability to clamp down on workplace-pressure, potentially saving lives? Or are they shying away from it because they prefer to stik to what they know? Time to get out of the comfort zone and start doing some real work Mr Rudkin.

Jonny Johal, Pharmacy Area manager/ Operations Manager

Guys, I have to say I have experience of working with pharmacists who do their best not to go over and above the call of duty. You guys thinking this must be contractors. 

Maria Uba, Primary Care Nurse

Nothing will be done.

Jonny Johal, Pharmacy Area manager/ Operations Manager

I totally disagree with the author, "funding to ease pressure and improve patient care" - he should recognise there is an economic reality out there. I have been working under pressure all my professional life, and I don't make extra errors when we are busier than normal e.g. Christmas. There is a more searching question which we need answers to, which is why are some pharmacists not coping with pressures that most of us are under, are they in the right job, are the universities recruiting the right people, is current training adequate, do we need to exclude certain personality types etc...?

C A, Community pharmacist

As an area manager - when was the last time you worked a full day in a pharmacy?

Jonny Johal, Pharmacy Area manager/ Operations Manager

Your question, CA, is irrelevant to the proposition. Unless the profession recognises that we do have an issue with some low ability pharmacists, we can’t move forward. I don’t believe that all and every pharmacist can deal with work place stress appropriately, and for those who can’t we should have a strategy to identify them, help them or manage them out of the profession to safeguard patients in hopeless cases. 

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Taking your assertion, how do you qualify someone who is underperforming? How do you support them? Respectively, could it be argued that if they are under your management you've failed to help them improve their own skills?

Jonny Johal, Pharmacy Area manager/ Operations Manager

There are many metrics I can use in my performance contracting sessions. Are you genuinely ignorant of these management techniques or being argumentative?

I say one thing to you, and borrow a phrase; my recruiting preference is to hire for attitude and train for skill, better to have a vacancy than an issue. You probably guessed which company I’m from now. 

Wolverine 001 , Pharmacist Director

GP's are going to get a massive windfall and pharmacy will not get a penny!!! Get used to it, we are not looked upon as vital to the NHS - why cant a large hub deal with the repeat prescriptions and have one or two pharmacies in the area dealing with queries!!

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Logistically, is that not a description of Pharmacy2U and such like business?

Ilove Pharmacy, Non Pharmacist Branch Manager

http://www.bbc.co.uk/news/uk-england-nottinghamshire-42735588

 

Maybe have a look at this Jeremy and give us your unbiased views -------- if you're allowed to that is. The editor and his colleagues it seems are not even allowed to acknowledge it even happened.

Barry Pharmacist, Community pharmacist

Good point ilove. Boots said. "Pharmacies are generally busier in the run up to Christmas as patients want to make sure they have their medicines, but this particular pharmacy was fully staffed. 

So what is 'fully staffed' Mr. Meader in your opinion? 

And if Boots and other pharmacies are fully staffed then why does the DoH need to spend more money on pharmacy? We cannot have it both ways. 

In my opinion funding is inadequate for safe levels of staffing but if pharmacy chains were given more funding the last thing they would do with it would be provide more staff. They would need to be forced to do it. That means staff ratios according to workload. Chance would be a fine thing.

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