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Good Practice Statement for the Preparation of Injections in Near-Patient Areas, including Clinical and Home Environments
FOREWORD
'Patients rightly expect that their stay in hospital will be as safe and comfortable as possible.'
Our National Health:
A Plan for Action, a Plan for Change.1 'The promotion of a culture of patient safety within local services is an integral part of clinical governance.'
Building a Safer NHS for patients.2 |
The publication in July 2001 of the Report of the Bristol Royal Infirmary Inquiry
3 reinforced the messages in our guidance on clinical governance
4 that Trusts should have systems and policies in place to support all health professionals in their responsibilities for providing safe and effective care and driving up the quality of care. The consultation on the Quality and Standards Board for Health in Scotland
5 in March 2002 emphasised the need to integrate patient safety issues with other aspects of the quality and clinical effectiveness agenda.
No therapeutic or diagnostic intervention is risk-free, but generally the benefits of medicines greatly outweigh the risks. The publication of
An Organisation with a Memory6 in 2000 by the Department of Health in England, was followed by
Building a Safer NHS for Patients in 2001, which identified targets for reducing key risks in healthcare. One of these was to reduce to zero the number of adverse events due to the maladministration of intrathecal drugs by the end of 2001. The Association of Scottish Trust Chief Pharmacists expressed concerns that the administration of all medicines by injection is associated with risk and there is a lack of consistency in the standard of practice for the preparation of injections. This concern was reinforced in the Audit Commission report
A Spoonful of Sugar7 which drew attention to the risks to patients associated with preparation of intravenous medicines at ward level.
It was particularly timely therefore, when a proposal was put to the Clinical Resource and Audit Group (CRAG) to establish an Expert Group on the Preparation of Medicines for Injection. Dr John Browning agreed to chair the Expert Group which would be multi-professional and would include patients' views. Injections are prepared in diverse settings including wards, theatres and people's homes, as well as in pharmacies. They are prepared by medical, nursing, pharmacy and other healthcare staff, and sometimes by patients themselves when managing chronic conditions. It is important to ensure that the right method is followed in the right setting for the right circumstances in order to minimise the risks.
This Expert Group was established to develop good practice statements on:
The principles for the prescribing of medicines for injection. The most appropriate location for the preparation of medicines for injection. The standard required for the environment, procedures, and operators involved in the preparation of medicines for injection.
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The good practice statements apply to all injections for patients, wherever they are prepared. This includes hospitals, community pharmacies, GP and dental surgeries, nursing homes and patients' homes.
The Expert Group has worked quickly and efficiently to produce this excellent, clear guidance which will have a significant impact on actual practice. Staff in our hospitals and in the community who prepare injections, and patients on long-term therapies involving injectable medication, will have clear guidance about how to minimise the associate risks.
I have recently consulted NHSScotland on proposals to improve patient safety in a publication entitled
Learning from Experience, which refers to this important initiative. These good practice statements are sound recommendations which will improve the safety of patients in NHSScotland and I commend them to you.
Dr Mac Armstrong
Chief Medical Officer
December 2002
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