Tinashe Nyamande | Market Development Manager – Ready-to-Administer Medicines | B. Braun Medical Limited
When the system is stretched In an Emergency Department (ED), several clocks run at once with assessment, observations and medicines preparation often occurring simultaneously. Once prescribed, an injectable medicine must be checked, prepared and administered. Preparation alone can involve multiple steps, including reconstitution, dose measurement and labelling (Deacon, 2025).
Suspected sepsis illustrates the importance of a dependable pathway. For adults at high risk of severe illness or death from sepsis, NICE recommends intravenous antibiotics within one hour of the first NEWS2 score being calculated during the initial ED assessment, unless antibiotics have already been given (NICE, 2025).
NHS England recorded 2.34 million A&E attendances in August 2026 with 75% of patients admitted, transferred or discharged within four hours. This was below the 95% operational standard, highlighting some of the challenges facing the NHS (NHS England, 2026a). NHS England has warned that hospital crowding remains a significant threat to both patient and staff safety (NHS England, 2025b). These pressures are compounded by workforce shortages. On 31 March 2026, NHS statistics recorded 21,643 registered nursing vacancies, including midwives and health visitors (NHS England, 2026c).
Against this backdrop of rising demand and workforce shortages, attention naturally turns to areas where clinical time might be used differently. Does the injectable medicines preparation pathway present an opportunity to release clinical time without compromising safety?
Rethinking the work before the dose
In an editorial for the Association of Anaesthetists, Lomas and Whitaker (2026) question why clinicians continue to prepare so many medicines at the point of care when many other healthcare products, like toothpaste, are supplied ready to use. Furthermore, an earlier procedural analysis calculated that prefilled syringes could remove 30 of 52 preparation steps examined (Whitaker and Whitaker, 2024).
At the 2026 Clinical Pharmacy Congress, Sue Ladds of NHS England asked which injectable medicines the NHS should make, which it should purchase from licensed manufacturers, and where a mix is needed.
She introduced ten strategic principles from the NHS England Infusions and Special Medicines Programme, which favour the use of licensed ready-to-administer and ready-to-use products, where appropriate, over bedside preparation.
The principles recommend retaining NHS aseptic capacity for bespoke and complex treatments, supported by planning, investment and workforce development (Ladds, 2026).
Where would the released time go?
If suitable medicines no longer require bedside preparation, could a nurse spend more time monitoring a deteriorating patient, answering a concern, or completing a medicines check without interruption? Or would that time simply be absorbed into existing demand?
Clinical teams must evaluate and determine which presentations are most appropriate for clinical practice and what successful implementation would require. Evaluation should cover reassessment, incidents and near misses, staff experience, supply reliability and whole-pathway cost.
As part of the evaluation, NHS guidance also warns about confusion between similar-looking presentations (NHS SPS, 2025; 2026). Al-Rawi and colleagues’ review suggests that considering acquisition price alone misses potential impact on staff time, waste and errors, while cautioning that estimates depend on context and UK evidence is currently sparse (Al-Rawi et al., 2026).
If every clinical minute counts, the question is which preparation steps can be optimised, and how can leaders ensure any time released is redirected to patient care?
If your organisation is exploring opportunities to optimise injectable medicines pathways, get in touch at gb_anaesthesiaandivpharmartuteam@bbraun.com
References
- Al-Rawi, S., Greening, M. and Ladds, S. (2026) ‘Economic evidence for licensed ready-to-administer intravenous products compared with standard vials and ampoules: a systematic review’, Anaesthesia, 81(6), pp. 867–874. https://doi.org/10.1111/anae.70122
- Carter of Coles, Lord (2020) Transforming NHS pharmacy aseptic services in England. Department of Health and Social Care. https://www.gov.uk/government/publications/transforming-nhs-pharmacy-aseptic-services-in-england/transforming-nhs-pharmacy-aseptic-services-in-england
- Deacon, A. (2025) The Triple Win: How Ready-to-Use Medicines Benefit Patients, Staff, and the NHS. B. Braun Medical Ltd Value and Access Team. Unpublished thought leadership article.
- Ladds, S. (2026) ‘Make, market or mix—crafting the NHS injectables model of the future’, presentation at the Clinical Pharmacy Congress, 8 May. Presentation supplied for this article. Public programme: https://www.pharmacycongress.co.uk/conference-programme-2026/ism-programme
- Lomas, J.-P. and Whitaker, D.K. (2026) ‘We don’t make our own toothpaste, so why are we still “making” so many of our medicines?’, Anaesthesia. https://doi.org/10.1111/anae.70294
- National Institute for Health and Care Excellence (NICE) (2025) Suspected sepsis in people aged 16 or over: recognition, assessment and early management (NG253). https://www.nice.org.uk/guidance/ng253/chapter/managing-suspected-sepsis
- NHS England (2014) Guide issued on care contact time. https://www.england.nhs.uk/2014/11/care-contact-time/
- NHS England (2025) Urgent and emergency care plan 2025/26. https://www.england.nhs.uk/long-read/urgent-and-emergency-care-plan-2025-26/
- NHS England (2026a) A&E attendances and emergency admissions: August 2026 statistical commentary. https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2026/09/Statistical-commentary-August-2026-WE76sa.pdf
- NHS England (2026b) The Model Emergency Department: high-performing urgent and emergency care pathways. https://www.england.nhs.uk/long-read/the-model-emergency-department-high-performing-urgent-and-emergency-care-pathways/
- NHS England (2026c) NHS Vacancy Statistics England, April 2015–March 2026: experimental statistics. https://digital.nhs.uk/data-and- information/publications/statistical/nhs-vacancies-survey/april-2015---march-2026-experimental-statistics
- NHS Specialist Pharmacy Service (NHS SPS) (2025) Managing medicines safely in clinical areas. https://sps.nhs.uk/articles/managing-medicines-safely-in-clinical-areas/
- NHS SPS (2026) Mitigating the risks of manipulating injectable medicines. https://sps.nhs.uk/articles/mitigating-the-risks-of-manipulating-injectable-medicines/
- Whitaker, M.C.A. and Whitaker, D.K. (2024) ‘The impact of using prefilled syringes on a standard operating procedure for preparing injectable medicines in clinical areas’, Anaesthesia, 79(1), pp. 98–99. https://doi.org/10.1111/anae.16166
This article has been authored by B. Braun Medical Ltd