In March 2017, the World Health Organisation launched its third Patient Safety Challenge – Medication Without Harm. In the first of a series of articles, Alpana Mair, Head of Effective Prescribing and Therapeutics at the Scottish Government, sets out the themes of the initiative, and delves into the role of patient safety as an important component of healthcare delivery which is essential to achieve universal health coverage and move towards the sustainable development goals.
It is estimated that over half of medicines globally are prescribed, dispensed, or sold inappropriately. Medicines are the most common therapeutic intervention and in recognition of this, the goal of the challenge is to reduce severe avoidable harm by 50 per cent, over the next five years. It is estimated that globally the annual costs associated with medication errors are US $42 billon.
Like the previous challenges, this recognises that errors are not inevitable, but can be addressed by considering factors in the healthcare system. For example, human factors – such as fatigue – poor working environment, and staff pressures that might lead to errors during the stages of the medication process, which are prescribing, transcribing, dispensing, administration, and monitoring that result in harm and can result in death. Although the majority of errors occur on administration of medicines, they can occur at any stage of the process.
This article will set out the main themes of the challenge and the subsequent article will address more detail about the three flagship areas identified for initial work by each country, high-risk situations, polypharmacy and transitions of care.
The challenge sets out a strategic framework to consider the fundamental problems, and as pharmacists we might want to consider how we can play an active role in taking this forward:
Patients and the Public
Health literacy may be poor for some patients so how can we support them to make taking their medications safer? In the World Health Organisation (WHO) pack, material for patients includes enabling them to ask basic questions on ‘Know’ (knowing what their medications are); ‘Check’ (patient using the medication the right way); and ‘Ask’ (attaining information from the healthcare professional about their medication which would support them to take this appropriately).
Medicines
Within the pharmacy, the complex names and packaging of medications that can either ‘look alike or sound alike’ can be a common sources’ of error and medication-related harm that can be addressed. Information has also been produced to support patients with the safe management of their medication.
Healthcare Professionals
How do healthcare professionals need to work across the multi-professional teams to prevent any increase risk in harm to patients?
Systems and Practices of Medication
Consider how the process across the organisation could have an impact on the safety of medication use. For example, the process of prescribing medication for patients should be shared across the organisation so that the patient doesn’t receive conflicting messages. The culture across the organisation should also support multi-professional discussions regarding medication.
In order for the challenge to make improvements, key stages of the medication process have been identified: prescribing, dispensing, administering, monitoring and use.
Early priority areas as described above are set out in summary and it is helpful to consider how you might identify areas to address within the pharmacy setting by considering the following scenario:
Mrs W is a regular customer who is 58 years old. She has a history of asthma and COPD and you regularly dispense inhalers for her. Recently you notice that she has not been herself and has bought some over-the-counter remedies for back pain; co-codamol tablets after an injury of falling off the pavement a couple of months ago when the weather was bad and the ground slippery. The pain has stopped her from doing her normal activities and she tells you that she’s looking for some anti-inflammatories and something to pick up her mood and help her sleep. Her friend told her that Ibuprofen should help and St John’s Wort is a pretty good pick-me-up and she’s been taking these for the last month. She also presents a prescription for omeprazole for indigestion and heartburn.
The three early priority areas are:
Medication Safety in High-Risk Situations
This will be considering either situations where medications are high-risk or inappropriate. In the scenario above, the high-risk situation is the lady buying multiple medications and also the fact that some of the medications she is self-medicating with are medications that are known to either cause admission to hospital or have a higher likelihood of causing harm.
Medication Safety in Polypharmacy
As people suffer from multiple morbidities, they take more medications. The challenge is to ensure that the patient will gain benefits from these medications as they are added in and not experience any harm. In the UK, up to 11 per cent of all admissions to hospital have been estimated to be due to medications, with half of these being preventable.
Medication Safety in Transitions of Care
It’s important that as patients move to access care across care settings the same principles are applied. Therefore, as the lady approaches the pharmacy to add to her treatment we need to ensure that the medications are appropriate and that none of the medications are going to be harmful.
On 20th June the technical reports to support countries to implement this work were launched with a webinar and this can be found at:
www.who.int/patientsafety/medication-safety/webinar-launch.pdf?ua=1.
This year, the WHO agreed through the world assembly to establish the first World Patient Safety Day on 17th September.
