Missed and delayed medication putting A&E patients at risk, new report reveals
Patients in A&E are being put in potentially life-threatening situations due to missed doses of prescription medicines, according to a new report.
The Royal College of Emergency Medicine (RCEM) found people in A&E were not getting their medications on time and were missing doses needed to manage their illnesses – putting them at risk of getting worse.
Insulin for diabetes, Parkinson's drugs, epilepsy medicines and tablets for preventing blood clots are all time critical medicines (TCM).
If these drugs are delayed or missed, the patient can deteriorate and is at greater risk of complications or death.
While patients are advised to remember to bring their medications to A&E and to take them, there is also a responsibility on NHS staff to make sure this happens.
Despite the recognised risk of harm, the delivery of TCM is not consistent across emergency departments with long waiting times often contributing to this.
The study focused on oral levodopa for Parkinson's and insulin for diabetes, as these are common in patients in A&E and must be given on time.
Researchers used data from 136 emergency departments in the UK which submitted data for more than 13,000 people in A&E who were on insulin injections or levodopa.
The study, which was part of the College's clinical Quality Improvement Programme (QIP) which aims to improve the care of A&E patients, found more than half of these patients were not identified as being on TCM within 30 minutes of their arrival in an emergency department.
In addition, 68 per cent of doses were not administered within 30 minutes of the expected time.
"The findings contained in this report should serve as a call to action for both emergency medicine staff, as well as patients reliant on time critical medications, to ensure no dose is ever missed in A&E," said Dr Jonny Acheson, an emergency medicine consultant in Leicester who has Parkinson's, led the study.
He stressed that paramedics and emergency medicine staff need to ask patients what medications they take.
Plus, those with Parkinson's and insulin treated diabetes need to tell staff and take their medications with them if they visit an A&E.
"However, the NHS must think about how they identify people taking these types of medication and how they are able to ensure they receive their doses on time, every time while they are in the emergency department,' he added. "These medicines are critical to the quality of these patients lives and we have a duty of care to ensure that they receive them when they should."
Recommendations made by the QIP team include that patients on vital medications should be identified early when they attend A&E, to prevent any missed doses.
It added that systems need to be in place to ensure medication is given on time.
Dr Ian Higginson, RCEM president-elect, said that this a problem 'we should not be having to fix' and suggested long waiting times are partly to blame.
"It has risen to prominence because of the increasing number of our patients who are having to endure ridiculously long waits in our emergency departments - 12, 24, 48 hours and even longer,' he added.
He stressed that missing doses of medication for Parkinson's or diabetes is not just 'inconvenient' it can be 'dangerous' and have 'serious consequences'.
Parkinson's UK praised the RCEM's work while Diabetes UK said delayed or missed insulin doses can be a potentially life-threatening emergency.
An NHS spokesperson said: "We welcome this report and will look closely at the findings, to ensure any patient in need of time critical medicine does not lose out when in A&E and receives the medication they need or support to self-administer as they would at home.
"As the report makes clear, it is welcome to see improvements thanks to the hard work of frontline staff but more generally we know A&E waiting times are far too long and our upcoming urgent and emergency care plan will set out how we aim to bring these down ahead of next winter."
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