In a recent article released by Care Management Matters (CMM), Caroline Maries-Tillott, Quality Improvement Lead at West Midlands Academic Health Science Network, shares insights into a project on finding new ways to improve medication administration and explains what the Social Care sector can learn from the project’s findings.

Caroline states: “Service user safety is at the heart of everything we do in the health and social care sector. Safeguarding service users from avoidable harm, particularly those who are considered vulnerable such as care home residents, has become a heightened priority. This is not only because of the challenges brought on by the coronavirus pandemic but also due to the growing number of residents with high support needs. Residents with such needs rely heavily on multiple medications being prescribed correctly and efficiently and a robust and clear medicine safety framework being in place to ensure that service users are kept safe when being medicated.”

A 2019 report carried out by the Manchester Centre for Health Economics, showed that of the estimated 237 million medication errors occurring each year in England, 92 million of these errors took place in care homes.

The project run by Caroline and the West Midlands Academic Health Science Network in a care home in Sutton Coldfield, found that medication errors occurred more when there were interruptions to staff during medication administration. The project team worked to quickly establish a baseline for interruption occurrences during medication rounds with the time of day, number of interruptions and why the interruption occurred. Once the baseline was set the team attempted to reduce interruptions to rounds by 1/3 every month. Solutions to reduce said interruptions came from across the organisation and highlighted areas in practice, staff culture and protocol, which needed to be addressed or updated to limit interruptions. Off the back of this, a list of interventions was established.

The list of interventions included; ensuring all new staff and visitors knew how and when to escalate concerns about service users, that those administering medication handed over phones to other members of staff while doing each round, and the use of a handover communication book for non-urgent messages to be recorded. Though these interventions seem simple, over the month trial period the reduction seen in the number of interruptions far surpassed what the team hoped to achieve.

These kinds of learnings can be applied to other social care settings too, not just care homes. Interruptions can occur anywhere and can be detrimental to the safe administration of medication as it is often time-sensitive.

The improvements achieved by this care home from this particular project not only saw a major improvement in service user safety and quality of care, but also a significant culture shift within the staff team towards safer and more efficient medication administration.

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