Unlocking the potential of technology to transform aseptic services

Pharmacy aseptic units are a cornerstone of many critical NHS services; they provide sterile products such as injectable nutrition, chemotherapy treatment and central intravenous additive services (CIVAS). Aseptic services have teams of skilled pharmacists, technicians and assistants to dispense and prepare these treatments.

COVID-19 has amplified the need to transform aseptic services to deliver better clinical outcomes, improve patient experiences, and release time spent on operational tasks for healthcare professionals (HCPs). And technology is the key to this.

The added pressure to aseptic services and the NHS generally has encouraged innovation and different ways of working. The recent Lord Carter of Coles’ Transforming NHS Pharmacy Aseptic Services in England highlights how technology can support pharmacy aseptic services, increase capacity for HCPs, reduce cost to the NHS, and improve patient experience.

Key challenges facing aseptic services

One of the key challenges facing the aseptic units is staffing. According to the Transforming NHS Pharmacy Aseptic Services in England report, there are 36,000 vacancies in the nursing profession. While it is great to see an upsurge in applications to study nursing at university[1], it will still take some time before these vacancies are filled. This is why centralisation and automation can play an important role in the safe and accurate preparation of medicines in the aseptic units, reducing errors and freeing up nurses’ time to care for patients. According to a report published by the Queen’s Nursing Institute, 74% of community nurses find IT systems a more reliable way of working, so it is important these systems are aligned throughout healthcare organisations to ensure they are being utilised effectively. [2]

Even before the outbreak of COVID-19, hospitals were already running at occupancy rates above acceptable levels based on bed capacity, with rates greater than 95% occupied beds being common.[3] Additionally, there is a lack of investment in aseptic services to replace facilities. For pharmacy staff within the pharmacy aseptic unit there is a risk of exposure to hazardous drugs, and, along with nurses on the ward, are at risk of sustaining repetitive strain injuries if they use manual processes to prepare medication.[4]

Due to the backlog of patients caused by the pandemic, staff may be expected to see more patients to overcome this with the same resources, and many healthcare professionals are being moved from aseptic units to other areas of the hospital. In addition to these challenges caused by the pandemic, the demand on aseptic services is still rising. Looking at oncology as an example, the number of people diagnosed with cancer is expected to rise by 29% between 2016-2028,[5] increasing the critical need for safe and sterile environments to prepare treatments. With outdated systems and technologies, the aseptic services are at risk of medication errors and poor documentation. Aseptic services are one of those ‘behind the scenes’ services the NHS takes for granted until something goes wrong. [6]

On top of all of this, diseases and their treatments are changing, so how can the NHS tackle current challenges while preparing for the future?

The part technology will play

Medication management is a fundamental process for the NHS to ensure patient safety. Technology is helping to reduce pressures created by the pandemic, whether it’s online consultations, IV compounding workflows or automated dispensing cabinets for medicines. Automation is enabling hospitals to share data and increase interoperability, allowing seamless transfer of information between facilities. It is crucial that hospitals configure systems to meet demands now and beyond. What is built to serve current needs also has to be fit for future purpose – everything has to last in the long-term.

Embracing automation could improve safety by reducing medicine administration errors and free up healthcare professionals’ time to focus on patient care. For instance, to release nurses time to care, high-volume automated robotic batch production of specific products can produce ready-to-use medicines reducing the need for them to be prepared at ward level. A study at Guy’s and St Thomas’ NHS Foundation Trust suggests as many as 40 whole time equivalent of that organisation’s nurses per annum could be released by such a switch.[7] Additionally, automation can reduce time spent on back-office tasks, such as eliminating paperwork (and the resulting transcription errors). With barcoding technology, it can increase compounding accuracy and reduce the time spent on manual checks.

Long-term plan of the NHS

The NHS’ initial goal for aseptic services was to transfer 30% of wider outpatient activity to be community or home-based care.[8] This trend is likely to grow due to the scale of change resulting from the pandemic. This is where aseptic medicine production is critical to the success of this long-term plan to redesign outpatient services. From aseptically produced IV antibiotics, parenteral nutrition to specific treatments, advancements made in aseptic services can maximise care outside the hospital, alleviating pressures on HCPs and improving patient experience.

Additionally, there is increasing demand for the commercial sector to work closely with the NHS for collaboration and digital innovation. Although the commercial sector already provides approximately 30% of the aseptic production in England, it currently lacks the capacity to meet increased demand from an unmet need in the NHS.⁴ There is an urgency to change the way people work alongside technology to create capacity for clinicians to be where they are most needed.

Quality and safety are the top priorities for the aseptic services and automation and technology are the way to achieve these goals efficiently. Digital innovation will be critical in transforming not just aseptic services, but the NHS generally, as it continues to navigate the pressures posed by the current pandemic.

References

[1] Nursing in Practice. Surge in applications to study nursing but ‘more needed’. Available at: https://www.nursinginpractice.com/latest-news/surge-in-applications-to-study-nursing-but-more-needed/. Last accessed: September 2021.

[2] The Journal of mHealth - The Technology Enabling Nurses to Fight COVID-19. Available at: https://thejournalofmhealth.com/the-technology-enabling-nurses-to-fight-covid-19/. Last accessed: March 2021

[3] Transforming NHS Pharmacy Aseptic Services in England - A national report for the Department of Health and Social Care by Lord Carter of Coles; p12

[4] Transforming NHS Pharmacy Aseptic Services in England - A national report for the Department of Health and Social Care by Lord Carter of Coles; p25

[5] Transforming NHS Pharmacy Aseptic Services in England - A national report for the Department of Health and Social Care by Lord Carter of Coles; p16

[6] Transforming NHS Pharmacy Aseptic Services in England - A national report for the Department of Health and Social Care by Lord Carter of Coles; p17

[7] Transforming NHS Pharmacy Aseptic Services in England - A national report for the Department of Health and Social Care by Lord Carter of Coles; p23

[8] Transforming NHS Pharmacy Aseptic Services in England - A national report for the Department of Health and Social Care by Lord Carter of Coles; p21-22