Using our advice
This resource aims to equip healthcare professionals (HCPs) with tools to implement improvement interventions for the safer use of Time Critical Medicines (TCMs).
Getting started
Improvement work should encompass the entire medication journey, including prescribing, supplying, administering and monitoring. Organisations are encouraged to think beyond the medication type and consider patient factors and the wider clinical situation.
To achieve sustained improvement NHS England guidance on priority setting suggests multiple interventions using quality improvement methodology to develop reliable controls related to safety. Several strategies can be used, either alone or in combination. Small-scale change can be used to translate learning wider. For example, initial targeted interventions may begin within a single clinical area or patient group, with insights and lessons subsequently shared to inform improvements across other settings.
Understanding Time Critical Medicines
The challenge of preventing delays and omissions of TCMs is complex. The article Understanding time critical medicines to support improvement (SPS page) aims to increase understanding of the issues which is necessary for organisational engagement and the success of safety improvements.
Key strategies
Individuals using TCMs are cared for in all healthcare settings and engage with a range of HCPs. Therefore, a systemwide approach with input from a range of professional groups is required to implement safety improvements.
Collaboration
A collaborative approach is needed. This can be achieved by:
- engaging senior leaders (including executive sponsorship) at the earliest opportunity
- creating a core working group, including key stakeholders from a range of professional groups
- nominating a leadership team, with defined responsibilities, to provide necessary oversight
- involving local quality improvement (QI) teams to support with the use of locally-agreed QI methodology
- involving a business intelligence or information technology team to support with data collection, analysis and measuring the impact of interventions
Lived experience input
Using patient and carer stories can inspire, be a catalyst for change, and help engage leadership support. Understanding the lived experience of individuals deepens the understanding of the importance and complexities associated with the timely use of medicines.
Improvement initiatives should be co-designed with those with lived experience. The NHS England framework sets out how NHS organisations should involve patients in patient safety.
Consider using the resources below when developing and delivering safety initiatives.
- In this 9-minute video a carer shares her perspective on time critical medicines:
- A nurse with Parkinson’s disease shares her experience of how a hospital admission impacted her own symptom management and inspired her to get involved in improving TCMs:
- In this 20-minute podcast a professor in medication safety discusses patient held records and the importance of engaging patients in the safety solution:
- In these short films from Parkinson’s UK, individuals share their experiences of receiving their Parkinson’s medicines in hospital.
Identifying individuals using TCMs
Recognising and highlighting individuals using TCMs at the point of access to a service or care setting may prompt timely prescribing, supply and administration. Interventions to ensure robust processes are in place that lead to timely and accurate identification can be effective.
Empower patients to identify themselves to healthcare professionals. Prompts and awareness tools may include patient held resources, posters in reception areas, and information in patient letters and appointment communications. Examples of tools to empower patients are available on the NHS futures workspace (login required).
Using digital systems
Reviewing and optimising digital functionality can support safer practices by:
- using alerts to identify prescribed TCMs to support prioritisation
- enabling audit and monitoring data to inform local improvement work, for example, creation of dashboards
- ensuring robust processes for communication of information
Electronic Prescribing and Medicines Administration (EPMA) systems and their functionality vary widely between organisations and require local review and configuration.
In this 12-minute video a Medication Safety Officer (MSO) shares their experience of using EPMA systems to improve the safe transfer of TCM between care settings.
Access to medicines
Organisations should define processes for sourcing and supply of medicines, including any required equipment and consumables. This should include out of hours access.
Our guidance on Purchasing for safety (SPS page) and Managing medicines safely in clinical areas (SPS page) outlines organisational process design that can support timely access in clinical care settings.
In primary care, commissioning arrangements and pathways for accessing medicines via community pharmacy play a critical role. Robust pathways for medicine access must be defined and well known to HCPs, patients and carers across systems and interfaces of care.
Patient and carer empowerment
Encouraging individuals or their carers to take ownership of maintaining supplies of medicines, along with any related equipment and consumables, helps ensure timely administration. Active patient and carer engagement is essential. This should include counselling on the importance of these medicines, their time-critical nature, and providing clear instructions on how and when to obtain further supplies.
Supporting individuals to self-administer their medicines in care settings can empower patients in ensuring timely administration. The SPS article on self-administration of medicines (SPS page) outlines the principles and benefits to individuals and provides guidance on implementation. The SPS article on developing insulin safety across a system (SPS page) includes a section on the self-management of insulin and explores ways to help empower individuals to manage their insulin.
Medicine shortages
In this 13-minute short video the SPS and DHSC team introduce and demonstrate how the SPS Medicines Supply Tool (NHS log in required) can support HCPs in managing supply issues. They describe the tool’s purpose and use, and explain potential actions to manage supply issues and shortages.
NHS England’s guide to the systems and processes for managing medicines supply issues in England details the processes and communication routes for medicines supply issues in England.
Upskilling healthcare professionals
HCPs involved in any stage of the medication process should have an understanding of TCMs and risks associated with delays. They should be equipped with the skills to identify TCMs and promote their safer use. For more information on understanding and defining TCMs, see our articles on Understanding time critical medicines to support improvement (SPS page) and Defining time critical medicines (SPS page).
Organisations should review opportunities to upskill HCPs. In this 23-minute video a medication safety pharmacist shares a toolkit and experience with tackling time critical medicines safety in their organisation.
Some examples of resources and guidance available from professional and charitable organisations to support the upskilling of HCPs are available on the NHS Futures workspace (login required).
Measuring improvement
Prior to starting an improvement journey, decide which outcomes will be measured. To obtain an understanding of current practice, collect baseline data before starting your improvement journey. This will help you to analyse the intervention’s effectiveness. Any possible unintended consequences that may arise as a result of the intervention should also be considered.
Some organisations have resources to support with measures for TCMs:
- NICE Quality Standard QS164 Quality statement 4: Levodopa in hospital or a care home
- Parkinson’s UK Time critical medication: 10 recommendations for your hospital
- RCEM Quality Improvement resources
Shared good practice
Sharing experiences with improvement interventions can help to prevent duplication, support efficient use of resources and promote standardised practice across the NHS. Examples of exemplar practice, and a discussion board to network with peers, can be found on the NHS Futures workspace (login required).
Webinar recordings
The recording of the 2025 SPS safer use of time critical medicines webinar is available in the 57-minute video below. This session is aimed at HCPs who want to improve safety with TCMs, working in any sector and role. The webinar describes the outcomes of an appreciative enquiry on TCMs, a carers perspective and two organisations share their experience with TCMs safety improvements.
Information presented during the webinars and associated videos was correct at time of recording. Current guidance should be followed.
Webinar resources
You can view presentations used during the session below.