This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Angela talks to us about how her role enables her to promote collaboration for patient safety between different layers of the healthcare system. She also tells us about how Northern Ireland is using World Patient Safety Day 2022 to help the public and healthcare staff understand how they can contribute to medication safety.
About the Author
Angela is the Lead Pharmacist for Medication Safety in Northern Ireland. With over 15 years in this role, Angela has a breadth of experience and expertise in medication safety and she is actively involved in cross-sector medication safety initiatives. Prior to her current role, Angela worked as a hospital pharmacist at a number of trusts in the North of England.
Angela has qualifications and experience in clinical pharmacy, management and leadership, patient safety and risk management, research and quality improvement. She has also recently completed a Postgraduate Diploma in Human Factors and Patient Safety at Staffordshire University. She is a Northern Ireland observer on NHS England and NHS Improvement’s National Patient Safety Response Panel and is an Associate Member of the Chartered Institute of Ergonomics and Human Factors.
Questions & Answers
Tell me who you are and what you do...
My name is Angela Carrington and I’m the Lead Pharmacist for Medication Safety in Northern Ireland. I lead the team of Medication Safety Pharmacists employed by our healthcare trusts and we work collaboratively across our region to prevent avoidable medication related harm and protect patient safety.
I’m also part of a team leading the implementation of our Department of Health response plan to the World Health Organization (WHO) Third Global Patient Safety Challenge ‘Medication Without Harm’. I was recently seconded to the Department of Health to support them to develop this plan, which is aligned to the four domains of the WHO Challenge.
My work is very diverse—it ranges from analysing reported medication incidents, to improving system resilience so that it supports safer medication practices, to delivering education and training programmes. Because I work at different levels within the healthcare system I can support policy development and change at a regional level, whilst also contributing to change at a practice level.
How did you first become interested in patient safety?
I remember going for my pre-registration pharmacist job interview and being asked what ‘clinical governance’ meant—the term had recently been coined following the Bristol Inquiry Report in the late 1990s. So I have had an understanding of the need for continuous improvement throughout my whole career, but practising medication safety really landed with me when I was inducted to my first ward. I asked my colleague for guidance on what my priorities were, and they said, “to make sure all the patients were prescribed their medicines safely.”
Working across many different hospital clinical areas during my early career, I quickly became aware that similar types of medication errors kept recurring. It made me realise that there must be weaknesses in the system—for example, in how we supported trainee doctors to prescribe safely. So I got involved in many initiatives to improve those areas of the system that contribute to safer prescribing, such as availability of guidance, design of prescription charts and effective training.
Which part of your role do you find the most fulfilling?
I find it very fulfilling working between the different layers of the healthcare system, with many different regional and national groups and organisations. It enables me to influence change that has a positive impact on medication safety at a population level. It also gives me the opportunity to interact with a diverse range of people and build new links and relationships, so I’m continually learning and identifying new perspectives. This is so important if we want to deliver medication safety that improves systems performance and wellbeing, as fundamentally it’s driven by and impacted on by people.
What challenges does your organisation face at the moment, related to patient safety?
It’s challenging to measure improvement of patient safety at a population level—WHO has asked us to reduce severe avoidable medication related harm by 50% within 5 years but finding a good measure of this is difficult. Reported incidents are not a viable measure, as reporting medication errors is voluntary and subject to many different kinds of bias. I think many countries are experiencing similar challenges, which WHO recognises, as it plans to issue some guidance about metrics.
I’m hopeful that as time progresses and our electronic systems mature, it will permit seamless transfer of information across organisational boundaries. As long as we have robust coding systems, it will be easier to measure safety in the future, which means we can deliver improvement much faster and on a wider scale.
What do you think the next few years hold for patient safety?
I think for us in Northern Ireland there will be many developments in medication safety as a result of implementing our WHO challenge response plan.
The essence of our NI response plan is a whole-systems approach, as we recognised that a societal-level change is needed to raise awareness and embed a culture where medication safety is everyone’s responsibility.
We’ve already made progress in two areas of work that support people to be aware of medication safety. One is a public call to action based on the WHO Know, Check, Ask campaign, which we started in our community pharmacies and plan to extend across our healthcare system to coincide with World Patient Safety day on 17 September 2022.
Another area of work is our Pharmacy Schools Programme, which is an interactive teaching resource available to primary schools across Northern Ireland. It uses a health literacy approach that considers the importance of medication safety as well as self-care. It will help to develop medication safety skills at an early age, and help children to consider the types of questions they should ask about medications. Going forward, we will continue to emphasise service user involvement and co-production in medication safety.
We are also doing some research to identify issues in the community that will help improve our understanding of people’s awareness of medication safety and how confident they feel to ask questions. Creating a societal shift where people feel that they can ask questions about their medications will be a positive cultural change. We want to move away from the prevailing mindset that people should ‘do as the doctor says’.
The digitisation of healthcare records in our hospitals and their increasing interoperability with primary care systems will be a game changer for patient safety. However, as with any system with a machine-human interface, it also will raise ‘new unknowns’ for medication safety.
New behaviours and practices will naturally emerge and we’ll have to be ready to respond to them. An aspect of digitisation that excites me is the potential to rethink our approach to safety, as we’ll be able to gather improved data on behaviours—for example, we will be able to look at what’s happening with medication practices and how close they are to potential error. We can then focus our attention on shaping the system to improve outcomes rather than reacting retrospectively following a poor outcome.
If you could change one thing in the healthcare system right now to improve patient safety, what would it be?
I would improve the labelling and packaging of medications, as often names and the outer packaging sound and look alike. It sets us up to fail at the outset, as medications can get mixed up in different environments—in the pharmacy, on the ward and even in the patient’s own home.
Look alike, sound alike (LASA) medications are a known global issue, so we need the pharmaceutical industry to focus their resources on not only producing safe and effective medication, but also designing products in a way that doesn’t introduce additional hazards. That requires consultation with product users in their real world setting at the medication prototype design stage to make sure the way the product is presented is safe and does not introduce new risks.
Are there things that you do outside of work which have made you think differently about patient safety?
During the Covid-19 pandemic lockdowns, I decided to take a Human Factors postgraduate course outside of work and that has definitely made me think very differently about patient safety. It made me really consider all the factors that interact with one another within a system to support safe practices. For one course assignment I had to do an environmental Human Factors assessment, so as I was working from home, I did my home office! I learned about how light, temperature and room capacity impact on my performance, wellbeing and ability to do my job. In fact, I realised that my light bulb emitted too much warm light and I actually needed a high blue-content bulb to increase my alertness.
For another assignment I had to analyse an educational training video and website on how to use an inhaler safely. It was really fascinating learning about inclusive, user-centred design which considers people’s physical, cognitive and social attributes. I’d certainly never encountered the term ‘anthropometry’ before—the scientific study of the measurements and proportions of the human body. As a mum of three children and with two elderly parents, I can really see how designing safer medication and information can’t have a one-size-fits-all approach, and we need to move away from designing to suit the ‘average’ individual, as they don’t actually exist.
Tell us one thing about yourself that might surprise us!
I was very keen on art when I was at school and had aspirations of going to art college, but my mum didn’t think it was a great career choice for me, and she was probably right. I have dabbled in art again later in life and surprised myself by selling two paintings! I definitely plan to return to painting when I find some spare time, perhaps when I retire.
You can view more information and a range of resources about World Patient Safety Day 2022 on the hub