7 April 2025
Patient safety is being put at risk in Emergency Departments due to missed doses of vital prescription medicines.
That is one of the findings of a study being carried out by the Royal College of Emergency Medicine (RCEM) which revealed that many patients who rely on prescription medication to manage chronic conditions such as Diabetes and Parkinson’s, aren’t always getting these vital drugs when in A&E.
These types of drugs are known as ‘Time Critical Medication’ (TCM) and, as the name suggests, it is important they are taken at specific times.
If a dose is delayed or missed, it can cause a person’s health to worsen. And if this delay is prolonged, the consequences can be severe.
RCEM’s new report – Time Critical Medication QIP 2023-24 – published today (7 April 2025) coincides with Parkinson’s Awareness Month and comes ahead of World Parkinson’s Day this Friday (11 April 2025).
The research is part of the College’s clinical Quality Improvement Programme which aims to improve the care of patients attending Emergency Departments.
The three-year QIP examines how time critical medications are dealt with in practice when patients come to the Emergency Department and how clinical methods and patient safety can be improved. Today’s report reflects the findings of the first year of the programme.
Across the UK, 136 Emergency Departments collated and analysed data for people living with Diabetes and Parkinson’s, who take certain medication such as insulin injections and a drug called levodopa, taken as tablets or capsules.
Supported by Parkinson’s UK and Diabetes UK, the QIP found more than half of eligible patients (53.4%) taking TCM weren’t identified within 30 minutes of their arrival in ED.
Meanwhile, around 68% of eligible patients’ doses weren’t administered within 30 minutes of the expected time.
In response to the findings, the QIP team made the following recommendations:
The QIP team was led by Dr Jonny Acheson, an EM Consultant in Leicester, who himself has been living with Parkinson’s since being diagnosed in 2016. Dr Acheson is also the Director of Engagement at the Parkinson’s UK Excellence Network.
Responding to the first report, he said: “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.
“Everyone has a role to play – paramedics and EM 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 ED.
“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.
“Despite continued pressure on ED staff, they have shown great commitment and resolve as we strive for further improvements nationally.”
RCEM President Elect, Dr Ian Higginson, who leads on Clinical Quality for the College said: “The work Jonny and the team have done to highlight this issue and really raise awareness cannot be underestimated.
“This is an example of a problem we should not be having to fix in our EDs. It has risen to prominence because of the increasing number of our patients who are having to endure ridiculously long waits in our EDs – 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 ED and becomes embedded so that no one fears not being able to access their medication while in our care.
“It is really critical we get this right – and we are determined to do so.”
Juliet Tizzard, Director of External Relations at Parkinson’s UK, said: “People with Parkinson’s are at risk of significant harm if they don’t receive their medication on time, every time, and so we are proud to support the College’s vital work in this field.
“We have long called for people with Parkinson’s in hospital to get their medication on time but have found that over half don’t.
“We are grateful to the College for supporting our ‘Get It On Time’ campaign, which led NHS England to include timely administration of time critical medication in hospital as one of the key ambitions in its Medicines Safety Improvement programme.
“Our commitment is firm: we will continue to help health professionals deliver time critical medication to people with Parkinson’s through our dedicated tools, resources and support.
“We hope that combined, these programmes of work will make a real difference to time critical medication management and Parkinson’s care in hospitals.”
Helen O’Kelly, Assistant Director of Services, Communities and Improvement at Diabetes UK, said: “For people with diabetes, especially those needing to attend an Emergency Department, going to hospital can be a worrying experience due to concerns about a loss of control over their diabetes management.
“One in six people in hospital have diabetes, and 35% of them need to be treated with insulin during their stay. Having very high blood glucose levels as a result of a delayed or missed insulin dose can lead to diabetic ketoacidosis, which is a potentially life-threatening emergency.
“It is encouraging to see that, in the first year of the Quality Improvement Programme, there has been a positive shift in improvements. We look forward to seeing the results as the programme continues.”
The QIP publication comes after RCEM published an ‘Advisory Statement’ in conjunction with the Association of Ambulance Chief Executives and the UK Clinical Pharmacy Association.
The statement provides clear and practical guidance on allowing patients, who are able to self-administer their own time critical medications, to do so.
Meanwhile, alongside the College’s report, Parkinson’s UK has launched a new tool for healthcare professionals, which estimates the cost savings and outcome improvements to be achieved when time critical medication is implemented. The new dashboard and other resources for professionals are available on the charity’s website here.
The issue of TCM was highlighted by a recent Health Services Safety Investigations Body (HSSIB) report which focused on the death of an 85-year-old man with Parkinson’s, who spent three days in an ED.
Despite self-administering the first two doses of his medication, he was only given half of the subsequent doses he required.
The coroner’s inquest states that his poor Parkinson’s care contributed to his death, which occurred four weeks after his stay at in A&E.
RCEM’s Time Critical Medication QIP report can be found here.
Additional charts can be found here.
