ESCP Best Practice: Development, implementation and evaluation of a practical risk assessment process for the introduction of new medicines to clinical practice at an Acute Hospital.

Abstract

Introduction: Incorporating new medications into clinical practice can present potential risks to staff and patients. Risk assessment of new medicines procured into acute hospitals in the United Kingdom varies between organisations and national guidance is lacking. Existing processes required risk assessment of all new medicines, consuming considerable pharmacist resource.

Aim: To rationalise the risk assessment of new medicines at an acute hospital.

Setting: A 1300 bed, multi-site tertiary-referral teaching hospital, London, United Kingdom.

Development: A pharmacy working group, including formulary, governance, medication safety, and clinical leads, developed a rationalised risk assessment process. An initial triage was proposed to evaluate whether a risk assessment was required. Existing risk assessment tools were combined and adapted for use. A New Drug Panel (NDP) of pharmacy leaders was formed to review risk assessments.

Implementation: The process was piloted for 6 months; minor modifications were made and it was fully introduced in May 2022. Implementation included governance sign off and training of members of the NDP on utilisation of the tools.

Evaluation: Two years after introduction, 646 requests for new medicines were triaged and 196 (30%) required risk assessment. Fourteen requests were cancelled, so 182 risk assessments were reviewed by the NDP. The NDP recommended an additional 46 mitigations. Trends identified issues with unlicensed medicines, safe administration practices, communication and electronic prescribing.

Conclusion: A practical risk assessment process reduced risk assessments by 70%, releasing clinical pharmacist time. An expert NDP identified additional mitigations, reducing patient harm and ensuring safe incorporation of medicines into clinical practice.