The economics of medication safety: Improving medication safety through collective, real-time learning (OECD, 14 September 2022)

Summary

Too often in health and social care poor medication practices and inadequate system infrastructure result in patient harm, with as many as 1 in 10 hospitalisations in OECD countries potentially caused by a medication related event. This report considers the human impact and the economic costs of medication safety events, exploring opportunities to improve systems and policies and how to improve medication safety at a national level.

Content

Key messages

• As many as one in ten hospitalisations in OECD countries may be caused by medication related harm.
• One in five inpatients experience medication-related harms during hospitalisation.
• Over $54 billion (US Dollars) is spent on medication-related harm in OECD countries (cost from avoidable admissions due to medication related harms plus added length of stay due to preventable hospital-acquired medication-related harms).

This report is divided into four main sections:

1.      Medication-related harms and errors are not rare events and have significant economic impact

This section considers the human impact and economic costs of medication safety events and includes the following points:

There has been limited progress in improving medication safety due to a number of converging factors.

•  The occurrence of medication errors can lead to an erroneous feedback loop - compounding harms.
• Non-pharmacological treatment alternatives are underused despite their demonstrated effectiveness to treat several chronic conditions.
• Increasing use of pharmacological treatment for chronic conditions is a contributing factor to potentially dangerous polypharmacy.
•  Some patient groups are particularly at risk of medication-related harm, particularly older patients, patients taking anti-psychotic medications and people living with dementia.
•  The prevalence of inappropriate prescribing is substantial, and possibly increasing.
• In the OECD they estimate that there are over six million hospital admissions annually are the result of medication-related harm.
• Each year, more than one million hospitalised patients in OECD countries experience a preventable medication-related harm in hospital.

2.      Reducing inappropriate prescribing and improving the rational use of medicines

This section considers the importance of the rational use of medicines - ensuring the right medicine at the right dose and duration for the right patient. It includes the following points:

• The most common form of irrational use of medicines is overuse, such as inappropriate polypharmacy.
• The inappropriate use of antibiotics has led to growing crisis of antimicrobial resistance.
• Underuse of medications does not receive much attention, however it also contributes significantly to global morbidity and mortality.
• Regulatory and economic interventions can improve medication utilisation and reduce costs but require robust evaluation alongside implementation.

3.      Improving medication safety throughout the care pathway

• This section considers different national strategies to improve medication safety and includes:
• An overview of selected national medication safety regulations or strategies.
• Discussion of the role of pharmacovigilance and drug utilisation reviews.
• Consideration of the status and adoption of digitalisation and medication patient safety initiatives in different OECD countries.

4.      Building medication safety into the Covid-19 recovery

This section considering the opportunities as countries look to adapt their health systems to build medication safety into their Covid-19 response and recovery activities. It includes the following points:

• The dynamics created by Covid-19 can be used to accelerate change.
• Importance of improving the functionality of data for monitoring medication safety in real-time.
• Need to use good patient safety governance and transparency to build public trust.
• Leadership commitment is required to establishing and maintaining a safe, people-centred environment that enables reporting to medication safety surveillance systems.
• Investments should continue to build systems that capture patient experience of medication-related harms and medication side-effects.
• There should be greater support for people-centred care systems and shared-decision making.

Other OECD patient safety reports available on the hub

• Developing international benchmarks of patient safety culture in hospital (19 January 2022)
• The economics of patient safety: Strengthening a value-based approach to reducing patient harm at national level (June 2017)
• The economics of patient safety in primary and ambulatory care: Flying blind (November 2018)
• Culture as a cure: Assessments of patient safety culture in OECD countries (2 June 2020)
• The economics of patient safety part III: Long-term care (17 September 2020)
• The economics of patient safety: From analysis to action (21 October 2020)
• The economics of patient safety part IV: Safety in the workplace (10 September 2021)