Medicines Optimisation Happens at the Bedside. Not Just in the Pharmacy.

The NHS has a framework for getting medicines right. The gap is in how it reaches the patient.

Here is a number that should stop anyone working in NHS medicines in their tracks.

Up to half of all medicines prescribed for long-term conditions in England are not taken as intended.

Not half of some. Half.¹

The NHS spends approximately £20 billion a year on medicines. That means, by conservative estimate, around £10 billion worth of clinical intent dissolves somewhere between prescription and patient. Some is waste. Some is non-adherence. Some is a patient who left the hospital with a box of tablets and genuinely did not know what to do with them.

This is not a new problem. The NHS has had a framework to address it since 2015. Medicines optimisation is a formal, NICE-endorsed, NHS England-supported approach to getting medicines right for patients. It has four principles, a quality standard, and a national improvement programme behind it.

And yet the gap persists. Not because the framework is wrong, but because the hardest part of medicines optimisation happens in the one place the framework is hardest to operationalise: at the bedside, during an inpatient admission.

That is what this piece is about.

What medicines optimisation actually commits the NHS to?

Medicines optimisation means ensuring the right patients get the right choice of medicine, at the right time. It is defined in NICE Guideline NG5 and is NHS policy.²

The framework rests on four principles. Understanding the patient's experience. Evidence-based choice of medicines. Ensuring medicines use is as safe as possible. Making medicines optimisation part of routine practice.

Read those four principles again with a ward in mind. Not a GP surgery, not a pharmacy. A busy inpatient ward at shift change, with eight patients to a nurse, some in single rooms, some on their third medication change in four days.

Every one of those principles is achievable in that environment. None of them is easy. And the fourth one, making medicines optimisation part of routine practice, is the one that most consistently does not happen, because routine practice in an inpatient setting is not designed around it.

When people move from one care setting to another, between 30% and 70% of patients have a medicines error or an unintentional change to their medication. That is the transition problem medicines optimisation exists to solve.

Where the framework breaks down in practice?

On most wards today, a patient's interaction with their own medication is largely passive. A nurse brings it. The patient takes it. The chart gets signed. That process is clinically managed and, in most cases, safe.

But it is not medicines optimisation in the full sense of the framework. It does not involve the patient understanding what they are taking. It does not build the habit and knowledge they will need at discharge. It does not contribute to the kind of shared decision-making that NICE identifies as a core component.

Why does medication adherence break down during hospital stays?

An audit published in PMC examined self-administration of medication among competent inpatients with diabetes at a UK hospital. None of those on oral agents were allowed to self-administer. 43% of those patients were not even aware that a self-administration policy existed at the trust, and would have chosen it if offered.³

This is not an anomaly. The Healthcare Commission's 2005 review found that only 19.5% of eligible wards were offering self-administration programmes. Twenty years of policy guidance later, the picture has improved but not transformed.

The reason matters. It is not that clinical teams do not understand the value. It is that running a medicines optimisation programme at ward level, with proper assessment, documentation, audit trails and patient education, is genuinely difficult without the right infrastructure.

So the default persists. The nurse administers. The patient receives. And the opportunity to build the knowledge and confidence that protects that patient after discharge is missed, day after day, admission after admission.

What is the last mile of medicines optimisation?

The NHS Medicines Safety Improvement Programme (MedSIP), running from April 2024 to March 2027, has a clear ambition: reduce severe avoidable medication-related harm across the health and care system.

Within that programme, time-critical medicines sit as a specific priority. Delays and omissions of time-critical medicines, those where timing directly affects clinical outcomes, such as anticoagulants, anti-Parkinsonian drugs, and insulin, are widely acknowledged as a persistent challenge.⁴

These are not complex clinical problems. They are logistical ones. The patient needs their medication at a specific time. The nurse is in another room. The chart is not updated in real time. The drug comes late or is missed entirely.

Medicines optimisation is not a pharmacy problem or a nursing problem. It is a system problem. The solution runs from prescription to bedside to discharge, and the bedside has historically been the weakest link in that chain.

What does bedside technology change?

Med-Side is a connected bedside cabinet designed to support self-administration of medication (SAM) in inpatient settings. Its primary function is clinical: secure storage, timed prompts, guided administration, and a digital record that flows directly to the patient's EPR.

But the way it relates to medicines optimisation is worth setting out clearly, because it is not just about one product feature or one workflow step.

Understanding the patient's experience — Med-Side captures data on when patients access medication, whether they engage with dose reminders, and whether they raise concerns through the device. That data gives clinical teams a view of the patient's relationship with their medicines that a paper chart never could.

Evidence-based choice of medicines and ensuring medicines use is as safe as possible are primarily clinical decisions. They are not changed by bedside technology. But they are supported by it, because a connected cabinet that logs every interaction means the medication record is complete, accurate, and available in real time to the pharmacist, the prescriber, and the nursing team simultaneously.

Making medicines optimisation part of routine practice is where the impact is most direct. When the infrastructure at the bedside supports SAM, when the audit trail is automatic rather than manual, when the patient prompt happens without a nurse needing to physically administer, medicines optimisation becomes the path of least resistance rather than the additional step.

What does bedside technology mean for pharmacy teams?

NHS England's medicines optimisation framework places pharmacy at the centre of patient education, medicines reconciliation and post-discharge planning.¹

Bedside technology supports that role in a specific way: it gives pharmacists better data. When a patient is self-administering with a connected cabinet, the pharmacist can see from the EPR whether that patient is engaging with their regime, whether doses are being taken on time, and whether there are patterns that suggest a need for intervention before discharge.

That is clinical intelligence the pharmacy team has never had access to in real time before. It does not replace the ward round conversation or the medication review. It makes both more informed.

What question does this raise for NHS teams?

Medicines optimisation is not aspirational. It is NHS policy, backed by NICE guidance, a national quality standard, and a national improvement programme with specific targets.

The question for ward teams, pharmacy departments, and digital transformation leads is straightforward. If the framework is in place and the intention is there, what is the infrastructure that makes it possible at the bedside, at scale, without adding to the workload of teams that are already stretched?

The answer to that question is where the conversation about bedside technology belongs.

Frequently asked questions

References 

1.  NHS England / NICE. Medicines optimisation: what it means for patients. Available at: stpsupport.nice.org.uk/medicines-optimisation. The £20bn figure and adherence statistic are drawn from the NHS England medicines optimisation supporting materials.

2.  National Institute for Health and Care Excellence (2015). Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE Guideline NG5. Available at: nice.org.uk/guidance/ng5

3.  Mardani, A. and Sinniah, D. (2013). Self administration of medicines by inpatients: are we making any progress? Clinical Medicine, 13(4), pp.418-419. PMC4954323. Available at: pmc.ncbi.nlm.nih.gov/articles/PMC4954323

4.  NHS Specialist Pharmacy Service (2024). Understanding time critical medicines to support improvement. Available at: sps.nhs.uk/articles/understanding-time-critical-medicines-to-support-improvement

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