Comment

15.08.18

Medication without harm

Source: NHE July/August 2018

The World Health Organization’s (WHO’s) Third Global Patient Safety Challenge, ‘Medication without harm,’ is ambitious, but it must not detract from the ongoing work of healthcare professionals, writes consultant pharmacist Gillian Cavell.

On 29 March 2017, the WHO launched its Third Global Patient Safety Challenge, ‘Medication without harm.’ The goal of the challenge is to reduce the level of severe, avoidable harm related to medications by 50% over five years, globally. 

It has been stated that, worldwide, medication errors cost an estimated $42bn annually. Medication error as a source of avoidable patient harm and death needs to be formally addressed, and this Global Patient Safety Challenge is setting out a broad framework within which to reduce harm from medicines. Three priority areas for action have been identified: high-risk situations, polypharmacy, and transitions of care.

The high-risk situations referred to in the WHO Patient Safety Challenge include the use of certain classes of medicines which are more likely to be associated with adverse drug events – either because small errors can be associated with serious harm, or because of the vulnerability of the types of patients who are likely to be prescribed these medicines. 

These drug classes – which include high-strength electrolytes, anticoagulants, insulin, opiates, sedatives and chemotherapeutic agents – have been the subject of patient safety alerts issued by the National Patient Safety Agency and NHS Improvement (NHSI) in the past. The safe use of these medicines remains high on the medication safety agenda across the NHS, where systems and practices have been put in place to minimise the risk of errors. 

More recently, increased emphasis has been placed on the importance of deprescribing medicines known to be associated with harm in particular patient groups – especially where multiple medicines are prescribed (polypharmacy) – and ensuring effective communication of changes to medicines when patients are transferred between healthcare settings.

The goal that has been set certainly is a challenge. In order to demonstrate a reduction in medication-related harms, we need to be able to measure the current rate of ‘harm.’ This is not going to be easy. We know that medicines and medication errors can cause ‘harm,’ but not all ‘harm’ is caused by medicines – and not all medicines use causes ‘harm.’ If it does occur with medicines use, that harm might not be preventable, as is the case with adverse drug reactions. The challenge specifically refers to severe harm, but the degree of harm is not specifically defined. 

Where adverse incidents do occur, there is an expectation for those incidents to be reported either through the National Reporting and Learning System or, in the case of adverse drug reactions, to the Medicines and Healthcare Regulatory Agency via the Yellow Card Scheme. 

However, as our reporting systems are voluntary, the data cannot be assumed to be complete. Qualitatively, the data is important and relevant, but when it comes to actual numbers of incidents resulting in harm, quantitative analysis is not reliable.

The increasing use of information technology – especially electronic patient records, electronic prescribing and electronic prescribing & medicines administration (EPMA) – enables the capture of data on the quality of prescribing and medicines use. Such systems have been used widely to support the development of safer ways of using medicines. Indicators of safe prescribing in hospitals which could be used to develop clinical decision support within EPMA systems have been described. The use of antidotes to reverse potential drug-related harms can be measured and has been used previously as part of the Medication Safety Thermometer to measure medication-related harm. 

We need to ensure that the technology that is increasingly being used to optimise medicines is designed to provide the information we need to measure its impact on the care we give to patients in the NHS. 

The challenge is to refine and combine existing intelligence around the safe use of medicines and potential harms associated with medication errors and link these to actual patient outcomes within the electronic databases currently being used or developed for use within the NHS. Where technological interventions have been shown to improve the way medicines are used, learning should be shared with NHS England for wider implementation.

The first metric for medication-related harm, which links safe prescribing of non-steroidal anti-inflammatory drugs in general practice and harm manifesting as admission to hospital due to gastrointestinal bleeding, has been published by NHSI. As further metrics for use in primary and secondary care are developed, the extent to which medicines are managed safely across our health system can be identified; and where preventable harms are identified, improvements can be made to reduce risks to patients.

However, the requirements of ‘Medicines without harm’ must not detract from the ongoing work of the healthcare professionals, including the medication safety officers who strive to achieve the safe use of medicines across the NHS on a day-to-day basis.

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Council and NHS consider merging into a single public authority

20/09/2018Council and NHS consider merging into a single public authority

Scottish Borders Council has put forward plans for a single public authority in the region in a proposed submission to a local government review.... more >
Sir Robert Francis chosen as new Healthwatch chair

20/09/2018Sir Robert Francis chosen as new Healthwatch chair

Healthwatch England has appointed Sir Robert Francis QC as its new a chair, taking over from current chair Jane Mordue after her three-year tenur... more >
Integrated care systems ‘need dedicated funding and law changes to succeed’

20/09/2018Integrated care systems ‘need dedicated funding and law changes to succeed’

National health leaders need to invest time into developing appropriate legislation, reforming regulation, redesigning financial architectures an... more >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Lord Darzi: Seize the opportunity

19/09/2018Lord Darzi: Seize the opportunity

Professor the Lord Darzi of Denham is the Paul Hamlyn chair of surgery at Imperial College, a surgeon working in the NHS and, from 2007-09, was health minister under Labour. Here, he highlights the importance of innovation in the NHS, and the exciting prospects it might bring if we’re brave enough to seize the opportunities ahead. Seventeen years ago, I performed the first operation in the UK using a surgical robot. As it happens,... more >
read more blog posts from 'the scalpel' >

interviews

Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >
Tackling infection prevention locally

04/10/2017Tackling infection prevention locally

Dr Emma Burnett, a lecturer and researcher in infection prevention at the University of Dundee’s School of Nursing and Midwifery and a boar... more >
Scan4Safety: benefits across the whole supply chain

02/10/2017Scan4Safety: benefits across the whole supply chain

NHE interviews Gillian Fox, head of eProcurement (Scan4Safety) programme at NHS Supply Chain. How has the Scan4Safety initiative evolved sin... more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... more > more last word articles >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

health service focus