Published: 20/12/2001, Volume III, No. 5786 Page 6 7

NHS managers face a 'daunting agenda' if they are to carry out the urgent reforms needed in hospital pharmacy, according to another damning Audit Commission report.

The report, published this week, claims that thousands of patients are killed through medication errors and adverse reactions to drugs.The NHS is also spending an estimated£500m treating those harmed by drug treatment.

Blame centres again on management failings. But inadequate care and, crucially, a serious lack of IT support, are also highlighted. The report describes the introduction of electronic health records and electronic prescribing - seen as fundamental to improving hospital pharmacy - as 'painfully slow'.

Over the past decade, deaths from adverse reactions to medicines have risen five-fold - in 2000, around 1,100 patients died compared with just over 200 in 1990.

Medication errors cause over 150 deaths a year, and one-fifth of clinical negligence litigation results from medication errors.

But according to the commission, the reasons for the poor state of hospital pharmacy are complicated: 'Shortcomings in doctors' knowledge means there is a particular risk of medication errors when they first arrive in hospital.

Only a small proportion of new doctors believe their induction dealt adequately with medicine management issues.'

Staff shortages are also cited.

One in six pharmacy posts are vacant - one reason why half of all UK hospitals are unable to provide a full range of pharmacy services.

The commission says too few trust boards have understood the importance of the link between effective clinical governance and medicines management. Many still see pharmacy services as a 'technical support service rather than a core clinical function'.

But it is in the area of IT that the commission made some of its most damning criticisms: 'Errors are mainly caused because the prescriber does not have immediate access to accurate information, either about the medicine or the patients. Hand-written prescriptions also contribute to errors as they may be illegible, incomplete and subject to transcription errors.'

The report says trusts - struggling with competing priorities and deficits - are filtering away some of the£60m provided for IT under the Information for Health strategy. Only one in three executive directors surveyed had clear plans for electronic health records and electronic prescribing - and less than 10 per cent of trusts will meet the 2005 deadline for their introduction.

Each hospital will need around£2m to set up the system, with£500,000 in annual running costs.

But the money should be recouped by 'eliminating a large proportion of the£500m' wasted on treating patients harmed by medication error and adverse reaction.

A Spoonful of Sugar.

Audit Commission.

Audit Commission: recommendations

National system of barcoding medicines to support electronic prescribing systems and automated dispensing.

Earmarked fund for trusts to comply with targets laid out in the NHS information management and technology strategy.

Risk-management arrangements reviews and 'fair blame', and introduction of 'near miss' reporting systems.

Elevation of role of chief pharmacist to the equivalent of clinical director, plus a place on trust's management executive.

lmmediate introduction of original pack dispensing.