Patients in A&E ‘risk getting worse because of missed medicine doses'
Patients in A&E are at risk of getting worse because of missed doses of prescription medicines, according to a new report.
The study, from 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.
Time critical medicines (TCM) are those prescribed to a patient for existing conditions, such as insulin for diabetes, Parkinson's drugs, epilepsy medicines and tablets for preventing blood clots.
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, the RCEM said.
And some of the issues are made worse by long waiting times to be seen in A&E.
Its new 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.
The research is part of the College's clinical Quality Improvement Programme (QIP) which aims to improve the care of A&E patients.
Across the UK, 136 emergency departments submitted data for more than 13,000 people in A&E who were on insulin injections or levodopa.
The findings showed that 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% of doses were not administered within 30 minutes of the expected time.
Dr Jonny Acheson, an emergency medicine consultant in Leicester who has Parkinson's, led the study. He said there has been improvements but more needs to be done.
'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,' he said.
'Everyone has a role to play – paramedics and emergency medicine staff need to ask patients what medications they take, and likewise, people with Parkinson's and insulin treated diabetes need to tell staff they take a TCM and take their meds with them if they have to visit an A&E.
'We are pleased that focusing on identifying these patients has led to improvement.
'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.
'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.'
The QIP team made recommendations, including that patients on TCM need to be identified early when they attend A&E to start the process of getting all doses.
Systems also need to be in place to ensure timely administration of TCM, including self-administration, and there should be a clear line of responsibility for staff.
RCEM president-elect, Dr Ian Higginson, welcomed the work.
He added: 'This is an example of a problem we should not be having to fix in our emergency departments.
'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.
'It is vital that ensuring patients receive TCM is identified as an issue associated with these waits.
'Missing doses of medication for illnesses such as Parkinson's or diabetes is not just inconvenient, it is dangerous; and missing multiple doses can have serious consequences.
'This first-year report reveals there is already some good work happening across the country.
'Now we just need to ensure that it is replicated in every emergency department and becomes embedded so that no one fears not being able to access their medication while in our care.'
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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