Islam Elkonaissi talks to Alison Moore about the benefits of closed loop systems for medication management – how they address the needs of the patient and minimise medication administration errors
Medication errors can occur at any point in the system for prescribing, dispensing and administering drugs in the NHS – and can often be the result of human errors creeping in as burned out staff misread or miscalculate the amount needed.
Over the last few years many NHS trusts have moved towards electronic systems which can reduce errors in one part of the process – around prescribing, for example – and have started to eliminate the steps which rely on bits of paper or healthcare workers doing calculations in their heads.
But relatively few have adopted what are called closed loop medication management systems – despite evidence that these can significantly improve patient safety. These combine electronic systems at the start of the process – such as electronic prescribing – with automatic dispensing cabinets with barcodes to ensure the right patient gets the right medicine. Cross-checking at all points in the process – including identity of patient - reduce the risk for error.
This allows the standardisation of many processes, enhances the use of automation at points in the system and facilitates full traceability through prescribing, dispensing and preparation, and administration.
Islam Elkonaissi, a pharmacist who worked within a closed loop system at Cambridge University Hospitals Foundation Trust, sees many benefits to closed loop systems.
“Basically, the whole concept of closed loop medication management is to address the needs of the patient and minimise medication administration errors” he says.
Making the best use of medication safely involves five “rights” – the right patient given the right drug at the right dose through the right administration route at the right time. But he would add to those – it should be prescribed for the right reason, with the right documentation and lead to the right outcome.
Over the last few years many NHS trusts have moved towards electronic systems which can reduce errors in one part of the process – around prescribing, for example – and have started to eliminate the steps which rely on bits of paper
“There is a risk of medication errors especially around administration,” says Mr Elkonaissi, who was the lead pharmacist for cancer services in Cambridge but is now working at the Mayo Clinic in the Middle East. “Closed loop medication systems look at a way of ensuring that everything will be double, or treble checked in an electronic pathway,” he says, adding that this is in line with the principles of medication optimisation put forward by the Royal Pharmaceutical Society, one of which is ensuring medicines use is as safe as possible.
“We are looking at a way of ensuring that everything that can go wrong on the process – from a prescription being generated, verified by the clinical pharmacist, manufactured or selected, bagged and administered after a bar code scanning, is minimised,” he says.
But he cautions that well thought through implementation is key to making the most of such a system. Part of this is around finding a shared language between clinicians and IT staff in order to avoid confusion. Where IT people may refer to “orders” for example, clinicians will always use “prescriptions.” “We have a real problem in addressing the jargon,” he says. “It is important that we are assured that everyone involved has a shared understanding of what they are talking about.”
Chief pharmacist information officers – a new role which is rapidly evolving within the NHS - can play a part in bridging this gap, he suggests.
And organisations should not skimp on training for people using these systems, he says, with the emphasis not just on ability to use them but also in becoming competent and confident in doing so. Training also needs to be suitable for all the groups who will use the system – whether doctor, nurse or pharmacist – and to reflect the different functionalities needed by specialities. How a system will operate in oncology – where many medications are manufactured on site – will be different from endocrinology and so on.
Over-alerting can be another challenge: this is where electronic systems display “flags” questioning, for example, whether the medication is appropriate for the patient. These can be very useful in avoiding prescribing errors but too many appearing on screen without adequate reasons can lead to healthcare workers just ignoring them and inadvertently overlooking the important ones.
Different trusts are implementing closed loop systems in different ways, he says, and there may be a case for some form of standardised implementation plan across the NHS. “We need to collaborate together to address common challenges,” he says. “Addressing the people, process and technology issues remain the cornerstone for collaboration, but we need not to underestimate the significance of simple things such as IT jargon”.
He believes that closed loop systems will offer much for the future – and in particular will allow the NHS to exploit the advantages of artificial intelligence. The amount of data which is collected through such systems will be important in developing AI systems and ultimately advancing precision medicine initiatives, he adds.