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Showing results for tags 'Medication'.
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Content ArticlePrimary care doctors traditionally provide a longitudinal and holistic view of their patients’ prescriptions, but there are barriers to general practitioners (GPs) carrying out effective reviews in complex patients with polypharmacy. These include unawareness of inappropriate prescribing; fear of the consequences of making changes to prescriptions; lack of self-efficacy (insufficient confidence to make changes); and lack of resources. GPs regularly carry out medication reviews for those taking multiple medicines, often with the support of pharmacists, but report a need for onward referral options to physicians specialising in multimorbidity and polypharmacy. In partnership with pharmacy colleagues, the authors of this study piloted an outpatient polypharmacy clinic, with the eventual hope of moving towards an integrated service. The pilot demonstrated the feasibility of establishing a specialist service in the secondary care or integrated care setting, dedicated to improving clinical outcomes for those experiencing problematic polypharmacy. This paper was published in Future Healthcare Journal.
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Content ArticleThis resource, written by the Royal College of Nursing, is intended for any registered nurse working with medicines as part of their role. The principles of medicines management however, apply across all health care settings and for non-registered staff.
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Content ArticleWhile approximately one in ten Americans suffers from a rare disease, only 5% of rare diseases have a U.S. Food and Drug Administration (FDA) approved treatment. Congressional and regulatory efforts to stimulate the development of rare-disease treatments, while laudable, have not resolved the fundamental issues surrounding rare-disease treatment development. Indeed, small patient populations, incomplete scientific understanding of rare diseases, and high development costs continually limit the availability of rare-disease treatments. To illustrate the struggle of developing and approving safe rare-disease treatments, this article from While approximately one in ten Americans suffers from a rare disease, only 5 percent of rare diseases have a U.S. Food and Drug Administration (FDA) approved treatment. Congressional and regulatory efforts to stimulate the development of rare-disease treatments, while laudable, have not resolved the fundamental issues surrounding rare-disease treatment development. Indeed, small patient populations, incomplete scientific understanding of rare diseases, and high development costs continually limit the availability of rare-disease treatments. To illustrate the struggle of developing and approving safe rare-disease treatments, this article from Julien B Bannister begins by discussing the approval of Eteplirsen, the first drug approved for treating a rare disease called Duchenne muscular dystrophy. After exploring the current drug regulation system and how this impacts the availability of rare-disease treatments, he examines the 21st Century Cures Act's patient experience data provisions and the pending Trickett Wendler Right to Try Act. Ultimately, the unmet therapeutic needs of rare-disease patients can be met while protecting patient safety. Bannister reasons that, if carefully implemented, the 21st Century Cures Act and the Trickett Wendler Right to Try Act could work in tandem to safely facilitate patient access to rare-disease treatments.
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Content ArticleThis good practice guide was been developed in consultation with an advisory group of leading clinicians specialising in dementia. It aims to provide evidence-based support, advice and resources to a wide range of health and social care professionals caring for people with dementia who have behavioural and psychological symptoms. It has been designed to be a practical, informative tool, with an emphasis on alternatives to drug treatment.
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Content ArticleThis population-based study of all Ontario nursing home residents found increased prescribing of psychotropic drugs at the onset of the COVID-19 pandemic that persisted through September 2020. Increases in prescribing were out of proportion to expected secular trends, and distinct from observed prescribing changes in other drugs during the pandemic. The authors suggest that the findings underscore the urgency of balancing infection prevention and control measures in nursing homes with the mental wellbeing of residents.
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Content ArticleAntipsychotic drugs are used to treat agitation, aggression, and psychosis in dementia when alternative strategies have failed. Their use has been reduced because of concerns about safety and limited efficacy. Drawing on data that the NHS publishes on a monthly basis on patients registered with a dementia diagnosis in England, this article considers evidence of an increase in antipsychotic prescribing to people with dementia during the COVID-19 pandemic.
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Content ArticleThe NIHR-supported RECOVERY trial has shown that tocilizumab – an anti-inflammatory rheumatoid arthritis treatment – reduces the risk of death for hospitalised patients with severe COVID-19. Researchers also found that the drug reduces the length of hospital admission, and the risk of patients requiring mechanical ventilation. Last year, the RECOVERY study was the world’s first to show that dexamethasone – a cheap and available steroid – reduces the risk of dying from COVID-19. The latest results from the study also suggests that for COVID-19 patients who have significant inflammation and require oxygen, a combination of a systemic corticosteroid – such a dexamethasone – alongside tocilizumab reduces mortality by about one third for patients requiring simple oxygen and nearly one-half for those requiring invasive mechanical ventilation. RECOVERY is now the second NIHR-supported study to demonstrate the effectiveness of tocilizumab as a treatment for COVID-19 patients, after results from the REMAP-CAP study last month showed that tocilizumab and a second similar drug called sarilumab have a significant impact on survival and can reduce the relative risk of death for critically ill patients in intensive care. The latest results from RECOVERY show that a much wider cohort of COVID-19 patients can potentially benefit from tocilizumab - beyond those critically ill on mechanical ventilation. For this preliminary report, information on the primary outcome was available for 92% of patients. Report has not been peer-reviewed yet.
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Content ArticleThe COVID-19 pandemic has exacerbated preexisting weaknesses in the global supply chain. Regional assessments by the Food and Drug Administration (FDA), European Medicines Agency (EMA), and independent consultants, have demonstrated various contributory causal factors requiring changes in policy, relationships, and incentives within the dynamic and developing networks. Human factors and ergonomics (HFE) is an approach that encourages sociotechnical systems thinking to optimize the performance of systems that involve human activity. The global supply chain can be considered such a system. However, it has neither been systematically examined from this perspective.
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Content Article
Medicines and prescribing are highly risky areas of health care. It is estimated that more than 200 million medication errors occur in NHS every year, and that avoidable adverse drug reactions (ADRs) cause 712 deaths per year, at a financial cost of at least £98.5 million every year.[1] Many medicines and prescribing issues have been highlighted in reports and investigations into patient deaths over the years, yet the issues around prescribing competency are yet to be fully addressed. It is time this omission was rectified. This blog explains why I believe patients, the public and healthcare practitioners, need to be aware of the Prescribing Competency Framework.[2] It outlines why the framework must be applied in practice, used in clinical supervision and CPD, and why we must all speak out of it is not being followed. The benefits of this will include prevention of unnecessary medicines being prescribed, avoidance of drug related harm, and lives saved.- Posted
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Content Article
Top medication errors reported to ISMP in 2020
Anonymous posted an article in Coronavirus (COVID-19)
One of the most important ways to prevent medication errors is to learn from errors that have occurred in professional practice and to use that information to identify potential risk points or practices to prevent similar errors. This presentation from the Institute of Safe Medicines Practices (ISMP), looks at the top medication errors reported in 2020. -
Content ArticleThe purpose of this study from Nanji et al. is to assess the rates of perioperative medication errors (MEs) and adverse drug events (ADEs) as percentages of medication administrations, to evaluate their root causes, and to formulate targeted solutions to prevent them.
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Content ArticleIt has been estimated that, on average, a serious mistake in medication administration occurs once in every 133 anaesthetic medications. Anaesthetic medications often have a narrow therapeutic window, raising the potential for adverse outcomes including harmful physiological disturbances, awareness, anaphylaxis and even death. Marshall and Chrimes in this editorial examine the causes of the medication‐handling problem and discuss solutions that address the human factors considerations.
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Content ArticleThe author of this review argues that, while many of us benefit from advances and new technologies used in medical drug development, there is one group that has barely made any gains at all: pregnant women. This review presents an overview of the current situation for this group, the issues and the available evidence; as well as exploring the barriers and options in better addressing pregnancy and maternal health. This document was written on behalf of the Birmingham Health Partners Centre for Regulatory Science and Innovation.
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Content ArticleWomen receiving treatment for epilepsy are being urged to discuss with a healthcare professional the right treatment for them if they anticipate becoming pregnant even sometime in the future, following a Medicines and Healthcare products Regulatory Agency (MHRA) safety review. Lamotrigine (Lamictal) and levetiracetam (Keppra) have been found to be safer than other antiepileptic drugs in pregnancy. The MHRA advises patients not to stop taking their current medicines without first discussing it with a healthcare professional.
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Content ArticleThis project includes the design of templates for controlled drugs, Hypnotics/Z-drugs, DMARDs (each orally administered drug has individualized template), NOACs, Warfarin, Lithium and Amiodarone. These templates prompt the user to add compulsory details before the drug can be issued for the first time or for a repeat issue. This has led to better and safer prescribing and potential to identify group of patients who either have not been reviewed or have missed essential monitoring. To avoid visual fatigue templates are short and to the point and a clinician can navigate away by one click if the required fields have been captured recently. Audits of prescribing such drugs has shown better prescribing and more patient involvement in decision making. Read more about this case study on the NICE shared learning database, via the link below.
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Content ArticleThis case study is featured on the National Institute for Health and Care Excellence (NICE) shared learning database. The associated project aims to optimise the safe use of medicines and reduce avoidable harm to patients. Objectives: To ensure prescribers in GP practices identify and report medication related incidents and near misses via the National Reporting and Learning System (NRLS) (Each practice was required to share at least 4 records with the CCG between April 2017 and March 2018) To enable CCG-wide learning opportunities and prevent further incidents in order to improve patient safety across the CCG (Themes and trends will be disseminated at least quarterly through the Prescribing newsletter). To ensure practices responded to patient safety alerts from the MHRA in a timely manner.
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Content ArticleThis article from Peden et al. reviews of some of the key topics and challenges in quality, safety, and the measurement and improvement of outcomes in anaesthesia. Topics covered include medication safety, changes in approaches to patient safety, payment reform, longer term measurement of outcomes, large-scale improvement programmes, the ageing population, and burnout. The article begins with a section on the success of the specialty of anaesthesia in improving the quality, safety, and outcomes for our patients, and ends with a look to future developments, including greater use of technology and patient engagement.
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Content ArticleThe National Institute for Health Research (NIHR)-supported RECOVERY trial has found no clinical benefit from the antibiotic azithromycin for hospitalised patients with severe COVID-19.
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Content ArticleAs prescription numbers continue to increase, it is necessary to understand the dispensing errors that can occur and how they may happen. This article is the first of two articles from Phipps et al. on dispensing errors and risk. Reducing risk and managing dispensing errors will build on the ideas proposed in this article.
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Content ArticlePharmacy teams should understand how to minimise the risk and likelihood of dispensing errors, including methods that can be used to evaluate existing processes, as well as how to deal with errors if they happen. This article from Phipps et al., in the Pharmaceutical Journal, builds upon the ideas proposed in ‘Understanding dispensing errors and risk’, and also proposes strategies and methods that should be considered for use in the pharmacy to manage the risk of dispensing errors.
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Content ArticleLaura Anne Jones MS (Member of the Senedd) tabled a formal written question concerning the implementation of the findings of the Cumberlege Review in Wales. This is the formal response from the Minister for Health and Social Services, Vaughan Gething MS.
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Content ArticleThe Medication Errors Group was established in 2017 under the leadership of Dr Brian Edwards and Professor Ian Wong.. Ensuring the safe and effective use of healthcare products is a key objective for those who work in pharmacovigilance, as well as all other stakeholders, including patients and caregivers. One key element of that is working to reduce and mitigate medication errors and other irrational use of drugs. The mission of the Medication Errors Group is To provide an opportunity for International Society of Pharmacovigilance (ISoP) members, and like-minded collaborators, to network globally in a professional and neutral environment, to share evidence and solutions that can ideally eliminate and/or at least reduce the number and severity of medication errors. This will enable continuous improvement in the use of medicines whilst supporting the interests of patients and their families, and healthcare professionals.
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Content ArticleIn 2008, the UK National Patient Safety Agency (NPSA) made recommendations for safe arterial line management. Following a patient safety incident in their intensive care unit (ICU), Leslie et al. surveyed current practice in arterial line management and determined whether these recommendations had been adopted. They contacted all 241 adult ICUs in the UK; 228 (94.6%) completed the survey. Some NPSA recommendations have been widely implemented – use of sodium chloride 0.9% as flush fluid, two‐person checking of fluids before use – and their practice was consistent. Others have been incompletely implemented and many areas of practice (prescription of fluids, two‐person checking at shift changes, use of opaque pressure bags, arterial sampling technique) were highly variable. More importantly, the use of the wrong fluid as an arterial flush was reported by 30% of respondents for ICU practice, and a further 30% for practice elsewhere in the hospital. This survey provides evidence of continuing risk to patients.
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Content ArticleSusan Warby, 57, was mistakenly given a glucose rather than a saline drip at West Suffolk Hospital after an operation for a perforated bowel in July 2018. Staff noticed a rise in blood sugar concentrations but gave her insulin to lower them rather than check the drip, which remained in place for 36 hours. In 2008 the National Patient Safety Agency made recommendations for safe arterial line management. In 2014 the Association of Anaesthetists published guidelines aimed specifically at preventing such events. Structured processes to prevent inadvertent use of a glucose-containing fluid to flush an arterial line and regular blood glucose sampling from a location other than the arterial line are only partial solutions. However, a survey of management of arterial lines undertaken in 2013 indicated that this was a common problem, that many of the NPSA recommendations were not widely implemented and that almost one third of respondents were aware of ‘wrong flush’ errors on their unit and a further third in other locations within their hospital. In this Rapid Response in the BMJ, Tim Cook says now is the time for patient representatives, clinicians, regulators and industry to work together to achieve widespread implementation of an engineered solution to prevent arterial line errors.
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Content ArticleIn 2008, the National Patient Safety Agency (NPSA) issued a Rapid Response Report concerning problems with infusions and sampling from arterial lines. The risk of blood sample contamination from glucose‐containing arterial line infusions was highlighted and changes in arterial line management were recommended. Despite this guidance, errors with arterial line infusions remain common. Gupta and Cook report a case of severe hypoglycaemia and neuroglycopenia caused by glucose contamination of arterial line blood samples. This case occurred despite the implementation of the practice changes recommended in the 2008 NPSA alert. They report an analysis of the factors contributing to this incident using the Yorkshire Contributory Factors Framework. They discuss the nature of the errors that occurred and list the consequent changes in practice implemented in their unit to prevent recurrence of this incident, which go well beyond those recommended by the NPSA in 2008.
