123 Improving medication management, safety and expenditure in a hospice inpatient unit through quality improvement

<h3>Background</h3> Medication management and medication safety are essential in specialist palliative care inpatient units, not least due to frequent use of high risk and critical medications. We describe a series of interventions actioned by the Drugs and Therapeutics Committee, over a 4 year period, that have resulted in an improvement in external inspection reports, substantial reduction in medication related incident reports and reduction in drug expenditure. <h3>Interventions</h3> Interventions included a complete overhaul of medication management and controlled drug policies and procedures. Second checks for medication administration after all medication rounds were implemented until omission rates became rare, and a new syringe driver replenishment procedure was instigated. Development of a nursing education programme, including regular face to face updates, annual e-learning medicines management mandatory training, and a medicines management workbook at induction. Prescribing errors reduced following introduction of a separate prescribing room, and policy of a second check for all prescriptions for new admissions and kardex rewrites. Quality improvement projects focusing on timely ordering of discharge medication, oxygen prescription, medication availability for emergencies through the introduction of ‘crisis kits’, improved information for GPs and alert cards for patients on methadone have shown sustained benefits. Work looking at high cost medications and ways to reduce these costs without compromising patient care has reduced costs significantly. <h3>Results</h3> Medication incidents reduced significantly in all areas from a peak of eight in Dec 2022 to zero in July 2024 and one in August 2024. There have been no incidences of delay in syringe driver replenishment since August 2022. Price of medications per bed per quarter has significantly reduced from £6191 in Oct-Dec 2022 to £2,749 in April-June 2024. <h3>Conclusion</h3> Having an active Drugs and Therapeutics Committee in a hospice setting can greatly improve medication safety and costs through implementation of a series of manageable interventions.