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NHS: Hospital Medication

Volume 753: debated on Wednesday 9 April 2014


Asked by

To ask Her Majesty’s Government what procedures will be put in place to ensure that every patient newly admitted to hospital will have their medication regime reconciled within 24 hours of admission.

My Lords, timely medicine reconciliation on admission to hospital can help to prevent medication errors, such as omitted and delayed medicines, wrong dose or wrong formulation. NHS trusts in England should have their own policies and procedures in place for the safe and effective use of medicines, taking into account joint guidance from the National Institute for Health and Care Excellence and the National Patient Safety Agency, which is now subsumed into NHS England.

I thank the Minister for her reply. In doing so, I declare an interest as I chair the APPG on Parkinson’s. Is she aware that people with Parkinson’s can take up to 30 tablets a day and that it is of vital importance that they have their medication on time every time? Does she agree that patients with Parkinson’s who are admitted to hospital should have the right to self-administration of their own medicine? That would put them in control and help to control their symptoms, and would certainly help staff. Will she take advice from Parkinson’s UK, which has great experience in this field, on how to train nurses to understand this task?

The noble Baroness speaks from a position of much expertise as the chair of the APPG on Parkinson’s. It is really important that people with Parkinson’s disease get the medicines that they need when they need them, whether they are being cared for in their home, in a care home or in hospital. The NHS is working to improve services for people with Parkinson’s disease. This includes ensuring that staff are properly trained to support people with Parkinson’s and other neurological conditions.

My Lords, does the Minister agree that the management of drug therapy for patients with parkinsonism may require exceptional skills? It is not a matter of taking tablets two or three times a day. The dosage and its timing must be tailored specifically according to the needs of the individual patient. If the timing of a particular dose is unduly delayed, this may result in what is called the on/off phenomenon, with a sharp return of disabling symptoms. It is therefore crucial that this matter be taken on board. Does the Minister believe that this issue, highlighted by the Question tabled by the noble Baroness, Lady Gale, is being properly handled in the NHS at present?

I can tell the noble Lord that NICE guidance suggests that people with Parkinson’s disease should have their medicines given at the appropriate time, not on the ward round with the trolley of regular medication. Where it is absolutely appropriate and possible, this may mean allowing self-medication.

My Lords, medication reconciliation is very important because it is a health and safety issue. Between 2003 and 2004, the National Patient Safety Agency declared that over 7,000 patients had been affected by an error with their medication. What are the Government doing to work closely with hospital pharmacies so that electronic records are shared between GPs and hospitals?

NICE, the NPSA and the Royal Pharmaceutical Society have all identified the key role of pharmacists in medicines reconciliation. I am pleased to say that the majority of hospitals now have pharmacists on admission wards and doing daily ward rounds to ensure patients’ medicines are reconciled promptly. On the data point, I understand that NHS England is exploring the possibility of developing a business case for pharmacists to have access to the electronic summary care record. However, any work on this will need to be sequenced into the development timetable along with other priorities.

When I was chairman of the National Patient Safety Agency, it produced the guidance that the noble Baroness mentioned. It identified the failure of reconciliation of medicines in acute admissions as a major patient safety issue. The failure rate in hospitals ranged from 10% reconciliation to 80% reconciliation. Those hospitals that achieved 80% reconciliation did so for one reason: pharmacists were involved. These are acute patients on multiple drugs. There is no other way except that those who know drugs and reconciliation are involved in the reconciliation of medicines on admission.

The noble Lord is absolutely right. Pharmacists need to show leadership and expertise and to support all their colleagues to ensure that this happens appropriately.

Will the Minister report on this morning’s report on the use of nanotechnology to suppress the disfiguring tremors experienced by Parkinson’s sufferers? What progress can be made there, and what can the Government do to improve it?

The noble Lord has me at a disadvantage because I have not seen the report to which he refers. I am sure that Parkinson’s UK is working with the research community to ensure that this is sorted out.

My Lords, are the Minister and the NHS aware of the new technologies which can deliver patients’ full medical records to a consultant’s iPad on the spot in a hospital? Is the NHS keenly pursuing those new technologies?

Certainly those technologies exist. I have seen some of them in action, and they are really impressive. Local hospitals are responsible for their own IT systems, and some are very much further ahead than others, but I am sure others are aiming to catch up.

My Lords, the Minister referred to the guidance on the reconciliation of medicines drawn up by NICE and the National Patient Safety Agency in 2007. However, since the Government abolished the NPSA two years ago and transferred the work to NHS England, information about the agency’s work and how it is being carried out and taken forward is very hard to come by. Will the Minister reassure the House that monitoring, keeping the guidelines under review and updating them to ensure patient safety are priorities for NHS England and the Government?

Patient safety is indeed critical. After Mid Staffs and the Francis report, safety, openness and accountability are key, along with the duty of candour. “Sign up to Safety” is to be announced later this week to ensure that efforts are reported. That will help local hospitals and care homes understand where mistakes are being made and make patients feel more comfortable by owning up to problems.