Special Report: Medicines Management

With Covid-19 forcing many clinicians to rethink the way they work, Jennifer Trueland investigates what role medicines management technology can play.

When Stephen Goundrey-Smith wrote a well-received paper on digital solutions for optimising medicines use in the UK, he identified three key factors that would help achieve the vision. These were; interoperability, appropriate flow of information, and manipulation of professional roles and boundaries by the entire system.

What he didn’t mention – not surprisingly as it was published in 2019 – was the transformative potential of Covid-19.

“Obviously this paper was envisaged well before the pandemic and I do think that in some ways Covid-19 has had a positive transformational effect,” says Goundrey-Smith, a pharmacist, consultant and writer.

“Across the NHS, a lot of things have been done in a relatively short space of time that might have taken a long time in other circumstances – some of these undoubtably have had a positive impact on the whole medicines and pharmacy digital agenda.”

Before the pandemic hit, work was already underway to implement standards to improve interoperability across medicine as well as the continuing development and adoption of electronic prescribing and medicines administration systems.

“I think a lot of the important developments I described in the paper are still continuing during the pandemic, despite quite a few challenges,” Goundrey-Smith explains. “But I think there’s been a lot of innovation in digital systems in the NHS as a result of the pandemic.”

Playing their part

Digital technologies are playing an increasing part in medicines management in the NHS – from electronic prescribing and medicines administration, to the use of robotics in dispensing and supply. This move to digital brings countless benefits to patient safety and to overall efficiency. When it works well, it makes the working lives of clinicians easier and improves patient outcomes.

Adoption of the new technologies has been accelerating, but this is not solely due to Covid-19.

“I think the pandemic has expedited the need for EPMA [electronic prescribing and medicines administration], although the benefits were already understood,” says Linda Elverson, head of prescribing at Civica.

“Covid-19 has provided the opportunity to accelerate more digitisation of services, but the NHS was already on the path towards EPMA.”

Trusts have wanted to accelerate EPMA programmes because of the benefits they bring, Elverson continues.

“It’s helping them to continue to provide patient care whilst minimising the risk of exposure and transmission,” she says.

“The desire to get EPMA out there as quickly as possible has certainly been promoted because of the pandemic.”

Other benefits include reducing movement between wards and care settings which is vital for infection control as it means contact can be reduced, Elverson argues.

“Remote access to medication information also helps clinicians to continue with their tasks,” she adds. “For example, clinicians who may need to self-isolate can continue caring for their patients.”

There are opportunities for healthcare organisations to do more around digital medicines management, and again, the pandemic has highlighted some of these, Elverson points out.

“As the adoption of EPMA matures, conversations develop into understanding how medicines management information and data can be built on and utilised further across boundaries in order to support the onward care of patients,” she says.

“It’s about how can we make the most of that information? What can we add to, how can we share it, where can we send it to help answer some of those other questions that sit around patient care?”

Surge in demand

Digitisation in general has been in greater demand during the pandemic, says Nervecentre CEO, Paul Volkaerts, and medicines management is a case in point.

However, while the demand is greater, there are some kinks which need to be ironed out.

“The rollout of medicines management systems over the last few years has quite often targeted the simple medicines and omitted the complex medicines,” Volkaerts says.

“You see a number of hospitals where they’ve implemented an EPMA, but the insulins are still on paper. That’s a reasonably common scenario.”

One of the reasons behind this, according to Volkaerts, is that if a system isn’t fully integrated and not able to handle the relationship between the complex medicine and the patient’s individual factors, it can be seen as higher risk – but Covid-19 has changed that.

“Not only has the pandemic driven the uptake of medicines management, it’s driven the uptake in medicines management when it comes to dealing with complex drugs, because it doesn’t do you any good to have part of the drug chart on an electronic system with a note on it to say ‘see paper chart’ when it comes to thing such as insulin,” Volkaerts adds.

“The irony about medicines management over the last 10 years is that in many ways, the most dangerous drugs were left on paper.”

While historically, complex medicines would be put in the “too difficult to deal with” category, Covid-19 has helped raised the bar.

Volkaerts argues the pandemic has helped with the evolution towards integrated medicine management systems which are able to handle complex drugs and can hold multiple pieces of information on patients. So instead of just having the drug chart, clinicians can also see things such as pathology information, blood sugar and blood pressure.

Changes in the industry

According to Phil Verplancke, product and ITS director at FDB (First Databank), there has not only been an increase in the usage of medicines management technology, but there have also been key changes in the industry’s dynamic.

“We work with many clients who provide electronic prescribing and dispensing systems in hospitals, and our clinical decision support solutions are used within many medicines management systems to provide quality and safety checks,” he adds.

“We have seen a marked uptake in FDB’s solutions in the last year, both in terms of the number of vendor partners integrating with our solutions and the number of trusts and other healthcare providers adopting electronic prescribing and medicines administration systems. We have also seen an increase in the engagement we are having with staff across these providers which is hugely beneficial.”

Over the last 12 months, the company had witnessed the collaboration dynamic evolve, Verplancke says.

“Working together to solve problems in the clinical front line is now much easier,” he explains.

“This is due in part to Covid, but also results from the frameworks that NHSX have created in the drive towards interoperability – for example, holding multiple hackathons and encouraging vendor involvement.”

Being highly usable

On a final note, when it comes to medicines management, what is needed is not only a robust EPMA system that supports patient safety but one that is also highly usable.

“You’ve got to have the right level of senior sponsorship internally, from an NHS perspective, and the right level of resources,” Elverson from Civica argues.

“And then you’ve got to have the right level of expertise to apply and align with the right level of acceleration through an EPMA programme at certain stages of a project.”

The pandemic has shown that the NHS can digitise at speed, she adds, and next steps will be how they can integrate the EPMA with other systems.

“There are lots of things outside of just a trust having their own EPMA system. It’s now about how you can take that information and it becomes something else that’s bigger for patient care,” Elverson concludes.