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The significance of the DHSC report on Transforming NHS Pharmacy Aseptic Services in England

Date: October 30, 2020

Category: Opinion piece

Author: Glen Hodgson

Conducted by Lord Carter of Coles, the report presents 18 recommendations on how these services can be transformed to make improvements across the NHS in England.

Glen_Hodgson_headshot_2018On 29 October 2020, the Department of Health and Social Care published a report “on the service providing sterile, controlled environments for the preparation of injectable medicines into 'ready to administer' formats for patients”.

Commissioned by the Minister of State for Health, the report, Transforming NHS Pharmacy Aseptic Services in England, serves to provide advice to the government, and NHS England and Improvement (NHSE-I), to regional, system, and trust pharmacy leads, as well as independent sector aseptic pharmacy providers.

What is the challenge?

Aseptic medicines are formulated within sterile environments to very precise guidelines to prevent contamination and to ensure patient safety. As such, administration usually takes place within acute care settings which requires a hospital stay, or visit, and limits the ability to provide care closer to home. Services cost approximately £4bn annually which equates to a little over three per cent of the budget of NHS England. 

However, the report identifies efficiencies that can save one million bed days and 4,000 whole time equivalent (WTE) staff every year. Better use of these facilities with the use of ‘ready to administer’ (RtA) medicines can lead to more patients being treated at home, releasing both workforce capacity and enabling financial savings.

Why is this significant?

In RtA forms, this will provide nurses with access to a wider range of standardised pre-prepared medicines to facilitate administration and reduce the risk of errors. This underpins one of the key points highlighted in the case for change for transforming services: “increased patient safety by reducing errors in the manipulation and administration of these medicines”.

The recommendations of the report make the suggestion to invest in hubs “to produce aseptic injectable medicines in England in order to create high volumes of aseptic pharmacy products to save time for nursing staff, enable care closer to home, and produce significant savings”. 

Where do GS1 standards fit in?

Of the 18 recommendations made in the report, the second pertains to “the how” – it states:

Working with Royal Colleges and pharmacy specialists develop national guidance for standard injectable medicines. The specification for dose banded chemotherapy products will be agreed, along with parenteral nutrition and antimicrobial medicines. The standard specifications (concentrations, presentation, volume, expiry time post preparation, labelling and coding in line with the NHS Dictionary of Medicines and Devices (dm+d) and GS1 barcoding standards). NHS commissioning policy should explicitly support use of standardised products.”

Over the years, GS1 UK have been working closely with NHSE-I and the Medicines and Healthcare products Regulatory Agency on the unique identification of medicines. This will allow greater visibility of medicine supply and use from manufacturer to patient bedside, creating a clear audit trail across the supply chain and clinical pathway. 

This recommendation underscores the importance of GS1 standards use for traceability – firstly, within the dm+d for the accurate identification of medicines and secondly, the use of LocationManager to provide visibility of medicines supply through accurate location identification.

Longer term, the report looks to speed up the closed loop medicines administration rollout within hospitals as well as addresses the more than 237 million medication errors made every year in England – the avoidable consequences of which cost the NHS upwards of £98 million and more than 1700 lives every year.