Using our advice
This resource aims to increase awareness and understanding of medicines that are more likely to cause harm if they are not taken at their intended timepoint. Alongside our article Improving the safe use of time critical medicines (SPS page) we provide insights and actions to promote organisational engagement with improving the safer use of time critical medicines (TCMs).
Importance of getting time critical medicines on time
Timely use of medicines is essential to their safe use and despite efforts to improve this, current practice is still leading to patient harm in the NHS. Patients suffer harm, distress and longer hospital stays when they don’t get their TCMs on time due to failure of medication processes. This can cause increased pressure for staff.
In some scenarios, delay or omission of treatment can lead to severe harm or deterioration. For example, in Parkinson’s disease, a delay of as little as 30 minutes can mean the difference between functioning well and not being able to move, walk, talk or swallow.
In this 11-minute video the Head of Patient Safety (Advice and Guidance) at NHS England discusses the ongoing harm being caused to patients and reflects on why it is so important to get TCMs right.
Defining TCMs
There is no universally agreed definition of TCMs, which adds to the complexity of improving the safe use of these medicines. Our article on Defining time critical medicines (SPS page) aims to support healthcare professionals (HCPs) in defining TCMs to support local improvements.
Prioritising TCMs safety improvements
Aligning TCMs improvement work to broader quality and safety improvement work within the organisation and national priorities may support engagement and local prioritisation. Some organisations have included TCMs improvement work into local Patient Safety Incident Response Framework (PSIRF) plans.
NHS England’s guidance on priority setting within an organisation states that prioritisation of resources should align with the organisation’s risk management strategy and consider national and integrated care system priorities. A collaborative approach should be taken to achieve better outcomes. The engagement required for effective improvement work requires organisations to prioritise resources.
Understanding local practice and harm
Collaborate with local patient safety teams including Medication Safety Officers (MSOs), Patient Safety Specialists (PSSs) and Patient Safety Partners (PSPs) to understand your local patient safety challenges that relate to TCMs.
Review of local data from incidents, complaints and harm reviews can support local understanding of risks and weakness within a system.
Although no longer an active patient safety alert, the 2010 National Patient Safety Agency alert Reducing harm from omitted and delayed medicines in hospital included an action to audit omitted and delayed TCMs. Some organisations may continue to undertake this audit which can be used to inform improvement work prioritisation.
National priorities
NHS England’s Medicines Safety Improvement Programme has prioritised work exploring how to improve care for individuals by ensuring that they receive the critical medicines they need on time. For updates see the safer use of time critical medicines programme article (SPS page) that gives an overview of the programme outputs.
National guidance and alerts
Reducing harms associated with delays and omissions of medicines has been widely acknowledged as a challenge for the NHS. The Health Services Safety Investigations Body page on medication-related harm links to a number of investigation reports and associated local level learning prompts related to the delay or omission of TCMs.
A number of archived patient safety alerts and investigation reports relate to delayed or omitted TCMs. Aspects of these previous alerts should inform broader local safety initiatives, as outlined in NHS England’s priority setting page.
A repository of historic patient safety alerts are available on the Medication Safety Across the System (MSATS) workspace on FutureNHS (login required).
Higher risk scenarios
The following scenarios are likely to increase the risk of treatment delays with TCMs.
Transfers of care
When individuals move between care providers or clinical areas, communication failures may exacerbate the risk of delay or omission of TCMs. An inability to access the individual’s most recent and accurate medicines history or delayed communications from acute or specialist services can contribute to this risk. NICE’s medicines optimisation guideline gives recommendations for medicines-related communication systems when patients move from one care setting to another.
In this 20-minute podcast the Medication Safety Officer for the London Ambulance Service and Associate Director for Medication Safety at SPS discuss improving the safety of time critical medicines at transfers of care.
Care outside of specialist setting
Individuals may be under the care of, or admitted to, a clinical area where staff are unfamiliar with the medicine and its time critical nature. Failure to recognise a dose of medicine as time critical may prevent timely actions to prevent delays.
Higher risk groups
Individuals with unstable or deteriorating conditions are particularly vulnerable to harm if their medication is delayed or omitted, as this can worsen their clinical status. In NHS England’s priority setting page, the patient safety team have advised HCPs to consider higher-risk patient groups. For example, those at increased risk of medication-related harm such as older people, people with a learning disability, neonates, or children and adults with a low body weight.
Podcasts
In this 13-minute podcast two medicines safety activists discuss what time critical medicines means to the system.
In this 18-minute podcast a consultant discusses what time critical medicines means to medics.
Webinar resource
The SPS Medication Safety across the System (MSATS) webinars are interactive sessions aimed at HCPs working in any sector with a role within, or passion for medication safety.
The recording of the full MSATS: Time critical medicines webinar recorded in 2023 is available in the 1 hour 22 minutes video below. The webinar supports the understanding of TCMs, the impact to the system and provides examples of good practice to support improving the safe use of time critical medicines.
Information presented during the webinar and associated videos was correct at time of recording. Current guidance should be followed.
Acknowledgements
We are grateful to our colleagues for recording the resources related to time critical medicines.