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PATIENT SAFETY
Medication without harm: Is it possible?
The Clinical Services Journal’s technical editor, Kate Woodhead RGN DMS, examines how the World Health Organization’s Global Patient Safety Challenge aims to reduce medication errors.
Medication errors are those which may lead to inappropriate medication use or patient harm. A report1
investigating the prevalence
and economic burden of medication errors estimates that there are 237 million events in England annually – 66 million of these are potentially clinically significant. There is little evidence of how medication errors lead to patient harm, the researchers had to use estimates from studies which identified harm from adverse drug reactions (ADRs). The NHS costs of definitely avoidable ADRs are £98 million per year, with 181,626 bed days implicated, causing 712 deaths and contributing to a further 1708 deaths. The identification of a major source of harm to patients follows the launch in 2017 of the third World Health Organization (WHO) Global Patient Safety Challenge “Medication without Harm” which aims to reduce the global burden of severe and avoidable medication related harm by 50% over five years. Recently the WHO has published three technical reports to help countries to focus on the three identified main causes of harm caused by medications.2
The normal process of prescribing and getting the medication to the patient is a complex process which involves a major number of steps and different healthcare professionals as well of course as the patient. Patients should expect that the healthcare professionals responsible for their care will communicate with them as well as with each other. In essence, the process follows a pattern: l The prescriber decides if a particular medicine or combination is indicated. Wherever possible, the patient should have a discussion with them at this point so that they are aware of the expected benefits and possible risks of the medication
l The medicine is prescribed, with the appropriate dose, frequency and duration
l The medicine is then dispensed and administered to the correct patient.
When errors occur
Most mistakes happen during the administration step of the process although
NOVEMBER 2019
it can occur at any time including storage, prescription, preparation, dispensing and monitoring. Poor prescribing comes in for some heavy criticism and is one of the elements which most scares newly qualified doctors and one in which they feel generally very unsupported. Prescribing problems have been described
as follows: l Overprescribing: This is defined as when the likely risk of harm exceeds the possible benefit in a specific individual. Thus every prescription should assess individual risk-benefit
l Underprescribing: In contrast, this occurs when a medication is not prescribed whose likely benefit greatly exceeds the risk of harm. The acquisition of sound therapeutic knowledge and skill by the prescriber is the key tool to minimise this risk
l Misprescribing: This happens when either the wrong medicine is prescribed or the wrong dose, route, frequency or duration of administration is chosen.
Patient medication
It is well known that adverse drug events occur most frequently at the extremes of age – ie: in the very young and in the elderly. The
very young and those of age are likely to be less tolerant to adverse drug reactions, either because their homeostatic mechanisms are not fully developed – especially in neonates and infants – or they may have deteriorated in the older person. Doses of medication which rely on dose calculation for the weight of an individual, especially a small child or baby, are particularly high risk. The risks in the elderly are much more likely to relate to the number of prescribed medications for co-morbidities. Unique items are prescribed for one disease and then a further disease as age increases. The traditional focus of medical research has been on a single disease, there has been little attention to multiple medicines and to the possible harm that may occur with polypharmacy. Globally, the prevalence of polypharmacy is set to rise as the population ages and more people suffer from long term conditions. There is evidence, but not yet enough to support regular medication reviews to reduce the opportunity for drug-drug and drug-disease interactions. Evidence shows that the most vulnerable
groups, often over the age of 65 years and living in care homes are at risk from higher
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