MEDICATION ERRORS
the issues in the NHS. The SLWG agreed that in an increasing digital age, further technological developments to aid patient safety were key. The roll-out and optimisation of electronic- prescribing and medicines administration in secondary care is important as the benefits are now well documented. These systems demonstrate, amongst other things, a substantial reduction in medication-related error, particularly when they have been optimised after implementation. In primary care settings, the use of
interventions such as pharmacist-led information technology intervention (PINCER) should be employed; which, by computer searches, identifies patients at risk from hazardous prescribing.10
Technology
is also to be used to encourage patients to ask questions about their medications. It is hoped that this will not only improve information available to patients but also encourage more joint decision making between the professional and the patient. It is clear from the report that the actions required cover all practice settings. It means designing safety into systems, recognising the increasing complexity of care for a population that is ageing and living with different health conditions and working closely with patients to ensure they are able to use medicines effectively.
WHO is working within its safety challenge to four key domains. The SWLG worked to the same framework, to consider possible areas for improvement. The four domains are: patients and the public; medicines as products; healthcare professionals; and systems and practices of medication.
Patients and the public
The Short Life Working Group (SLWG) agreed that shared decision making was a key aspect so that patients and their carers could be more actively engaged in their own care, be their own safety advocate and have more confidence to raise questions and concerns with clinicians regarding the drugs they have been prescribed. Knowledgeable patients may prevent some medications being prescribed and not being taken by the patient, because they don’t understand the value of them. Clinical Pharmacists working within primary care also offers many opportunities for better informed patients. Technological assistance may be developed in the form of apps to help to shape patients knowledge of medications, although it is recognised that this method of access will not be appropriate for everyone. Electronic prescribing systems are
generally considered to be safer from many aspects than manual records but it is important for patients to have easy access to their medication information and this may not always be available if it is only accessible electronically.
Health care professionals
Primary care, where most medicines are prescribed and overseen, inevitably has a higher incidence of medication harm. The ScHARR report suggests that 71% occur in primary care and that errors were more likely to happen to older people and in patients with multiple conditions and those using many medicines.
The SWLG identified that GPs need to be
supported by secondary care specialists to ensure safe and effective prescribing and monitoring of medication. Enhancing professional education for undergraduates and as continuing education together with re-validation is increasingly important. Initiatives such as a prescribing safety assessment for F1 doctors are recommended and should be built on. Junior doctors could be part of a scheme which creates a ‘pharmacy buddy’ to assist with medication safety. Recognising that there is an ever increasing number of professionals now prescribing, that they should all ensure they maintain their knowledge and competence.
In May 2007, one of the key global patient safety solutions was reducing the number of look-alike, sound-alike medication names which were contributing to medication error.
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Polypharmacy
The multidisciplinary team should work together to help reduce overmedication and inappropriate polypharmacy. Some strategies to reduce over prescription of medicines are already underway via the Medicines Value Programme.11
One strand of this programme
is to optimise the use of appropriate medicines by: l Developing and supporting the work of the four Regional Medicines Optimisation Committees to drive the changes that are needed in prescribing and medicines use
l Improving health outcomes from medicines through improving patient information, making best use of the clinical skills of pharmacists and pharmacy technicians, and implementing clinically effective prescribing and medicines reviews
l Supporting the anti-microbial resistance campaign – which focuses on reducing the overuse of antibiotics
l Increasing the use of best value biological and generic medicines, including biosimilar medicines where appropriate
l Decreasing or stopping the use of medicines which are neither clinically – or cost-effective
l Implementing the quality and innovation goals – known as a ‘CQUIN’ – for medicines optimisation within specialised services.
In addition to this by 2020/21, 2000 pharmacists will be deployed in primary care to review patients medication and reduce polypharmacy. There are additional proposals to assist appropriate prescribing in care homes.
JUNE 2018
©Diego Cervo 2012
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