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Community PostThe new Health and Care Bill gives NHS Digital powers to create a new ‘medicine registry’ The bill, published earlier this month, will allow NHS Digital to collect a range of information about the use of medicines and their effects in the UK and hold this data in one or more information system(s). The MHRA would be able to then use the information held in an information system to establish and maintain comprehensive UK-wide medicines registries. “This would improve post-market surveillance on the use [of] medicines. For example, where a safety issue has led to the introduction of measures to minimise risk to patients, registries would facilitate the early identification and investigation of potential noncompliance so that additional action can be taken by regulators in conjunction with health service providers at a national, local, or individual patient level.” The notes added the power is “restricted to purposes relating to the safety, quality and efficacy of human medicines and the improvement of clinical decision-making in relation to human medicines”. Anybody who inappropriately shares NHS data collected for the new registry could face a fine and a prison sentence. What does this mean for patient safety? What impact will this has on the NHS and for private providers? @Helena Gregory. @Kathryn Howard, @Kristen, @Alison Smith, @Phaeds, @CYC, @Dakota, @Steve Turner
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With addiction treatment programs, ensuring the safety of patients undergoing recovery is paramount. However, addressing medication safety within these programs can be a complex endeavour. As addiction treatment evolves to meet the needs of individuals on their path to recovery, it's crucial to adopt strategies that prioritise both the efficacy and safety of medications. In this blog, Dr Alexandre Kirk, Medical Director at Bright Futures Treatment Center in Florida, examines the various facets of medication safety challenges in addiction treatment programs and explores practical solutions to overcome them. -
Content ArticlePeri-operative medication safety is complex. Avoidance of medication errors is both system- and practitioner-based, and many departments within the hospital contribute to safe and effective systems. For the individual anaesthetist, drawing up, labelling and then the correct administration of medications are key components in a patient's peri-operative journey. These guidelines from the Association of Anaesthetists aim to provide pragmatic safety steps for the practitioner and other individuals within the operative environment, as well as short- to long-term goals for development of a collaborative approach to reducing errors.
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Content ArticleThis YouTube playlist containing 12 short vlogs (each lasting 10 minutes or less) is a cut-down version of Continuing Professional Development work commissioned by the NHS in England. These are part of our patient led clinical education work and involved working with patients, carers, and relatives as equals to produce the videos. These vlogs are based on the (UK) Royal Pharmaceutical Society Competency Framework for all Prescribers, and related guidelines from professional bodies in the UK. They are designed for clinicians (across all disciplines and specialities), patients, carers, parents, relatives and the public. The short videos focus on providing refresher information, updates on hot topics and materials that can be used for reflection both individually and within clinical teams. They cover: Shared decision making Information mastery Interpretation of numerical data Root causes on medicines and prescribing errors Taking a history Basic pharmacology Risk areas and red flags Ethics, the law and prescribing Deprescribing Remote prescribing Prescribing for frailty and multimorbidity Prescription writing and safe prescribing The original materials were accompanied by live sessions, questions for reflection (some of which are included here), separate refresher questions, detailed prescribing scenarios, and competency assessments.
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Content ArticleCoroners, who hold inquests to determine the causes of unnatural deaths in England and Wales, having recognised factors that could cause other deaths, are legally obliged to signal concerns by sending ‘Reports to Prevent Future Deaths’ (PFDs) to interested persons. This systematic review in Pharmaceutical Medicine aimed to establish whether Coroners’ concerns about medications are widely recognised. The authors found that PFDs related to medicines are not widely referred to in medical journals or UK national newspapers. By contrast, the Australian and New Zealand National Coronial Information System has contributed cases to 206 publications cited in PubMed, of which 139 are related to medicines. The research suggests that information from English and Welsh Coroners’ PFDs is under-recognised, even though it should inform public health. The results of inquiries by Coroners and medical examiners worldwide into potentially preventable deaths involving medicines should be used to strengthen the safety of medicines.
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Content ArticleExtravasation injuries occur when some intravenous drugs leak outside the vein into the surrounding tissue which can damage the tissue and cause serious harm to the patient. This is a survey for healthcare professionals on approaches to extravasation management outside of cancer care. It is part of a campaign led by the National Infusion and Vascular Access Society (NIVAS) to improve awareness of infiltration and extravasation to reduce avoidable harm.
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Content ArticleThe Digital Medicines Transformation Portfolio aims to use digital technologies to make prescribing, dispensing and administering medicines everywhere in Wales, easier, safer and more efficient for patients and professionals. It brings together the programmes and projects that will deliver a fully digital prescribing approach in all care settings in Wales. This video outlines the different elements of the portfolio that will be introduced across primary and secondary care, including the Shared Medicines Record, which will store information about a patient's medications all in one place.
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Content ArticleA patient advocate is someone who, with the patient’s consent, supports that person in their interactions with healthcare providers. This support can be provided during visits to a doctor's office, on a trip to the pharmacy, during a hospital stay, or when a nurse comes to visit in the home. An advocate can be a family member or friend, or it might be someone outside the patient's circle who offers or agrees to take on this role. An advocate can help in a variety of ways, including sharing information as needed and helping the patient understand and remember details from the visit. Having an advocate present, especially for individuals who find it hard to speak for themselves, can help prevent medication errors.
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Content ArticleFollowing an extensive process of internal and external engagement, the Medicines and Healthcare products Regulatory Agency has published their corporate plan for the next 3 years. Their priorities are: Maintain public trust through transparency and proactive communication Enable healthcare access to safe and effective medical products Deliver scientific and regulatory excellence through strategic partnerships Become an agency where people flourish alongside a responsive customer service culture.
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Content ArticleUS endocrinologist Richard Plotzker shares a recent experience of buying over-the-counter medication from a grocery store. When he opened the outer packaging, the blister packs were empty apart from one pill in each being resealed by scotch tape. Richard called the manufacturer and returned the medication for investigation. He describes how the incident highlights the need to be vigilant about any unusual appearance in the packaging of medication.
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Content ArticleVideo of the 10th Annual World Patient Safety, Science & Technology Summit presentations. The event fostered a high-level exchange of ideas and initiatives to improve global patient safety with expert speakers and panelists, inspiring messages from hospital executives, and the sharing of tragic patient stories. The programme ignited further momentum to reach ZERO harm. You can view all the speaker presentations by clicking on the image below. There is also a link to the Patient Safety Movement Foundation website with all the presentations at the end of the page.
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Content ArticleMaking data on medical interventions easier to collect and collate would increase the odds of spotting patterns of harm, according to the panel of a recent HSJ webinar. When Baroness Julia Cumberlege was asked to review the avoidable harm caused by two medicines and one medical device, she encountered no shortage of data. “We found that the NHS is awash with data, but it’s very fractured,” says Baroness Cumberlege, who chaired the Independent Medicines and Medical Devices Safety Review and now co-chairs the All-Party Parliamentary Group which raises awareness of and support for its findings. It was a challenge on which Professor Sir Terence Stephenson had cause to deeply reflect back in 2014. That was the year in which he was asked to chair an independent review of medical devices, following concerns about the safety of metal-on-metal hip replacements and PIP silicone breast implants. “The NHS stepped up to the plate really quickly and said: ‘Even if it’s a private hospital that put this in, we will take it out to protect your safety,’” recalled Sir Terence, now Nuffield professor of child health at Great Ormond Street Institute of Child Health and chair of the Health Research Authority for England. “But the big problem was they couldn’t identify who had which implants. No doubt somebody somewhere had written this down with a fountain pen and then someone spilt the tea over it and the unique information was lost.”
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Content ArticleMedication nonadherence - when patients don’t take their medications as prescribed - is unfortunately fairly common, with research showing that patients don’t take their medications as prescribed about half the time. The phenomenon has added consequences for patients with chronic disease. When this is the case, it is important for physicians and other health professionals to understand why patients don’t take their medications. This will help teams identify and improve patients’ adherence to their medications. This article by AMA, highlights eight reasons why patients don't take their medications.
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Content ArticlePatients often have multiple providers involved in their care. On the one hand, patients are able to receive specialty care to help manage multiple, complex medical conditions. On the other hand, such fragmentation in care may lead to medication errors from inaccurate or incomplete patient medication lists. As stewards of their patients' care, it is essential that primary care providers take steps to review and reconcile each patient's medication list to avoid errors or adverse drug events, and organisational leaders must ensure that systems are in place to support these efforts.
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This blog provides an overview of a Patient Safety Management Network (PSMN) meeting discussion on 9 June 2023. At this meeting, members of the Network were joined by Dr Henrietta Hughes, Patient Safety Commissioner for England. The PSMN is an informal voluntary network for patient safety professionals in England. Created by and for patient safety managers, it provides a weekly drop-in session with guests to talk through issues of importance to patient safety managers, providing information, peer support and safe space for discussion. Find out about the network. -
Content ArticleThe extent to which postintensive care unit (ICU) clinics may improve patient safety for those discharged after receiving intensive care remains unclear. This observational cohort study from Karlick et al., conducted at an academic, tertiary care medical centre, used qualitative survey data analysed via conventional content analysis to describe patient safety threats encountered in the post-ICU clinic. For 83 included patients, safety threats were identified for 60 patients resulting in 96 separate safety threats. These were categorised into 7 themes: medication errors (27%); inadequate medical follow-up (25%); inadequate patient support (16%); high-risk behaviours (5%); medical complications (5%); equipment/supplies failures (4%); and other (18%). Of the 96 safety threats, 41% were preventable, 27% ameliorable, and 32% were neither preventable nor ameliorable. Nearly 3 out of 4 patients within a post-ICU clinic had an identifiable safety threat. Medication errors and delayed medical follow-up were the most common safety threats identified; most were either preventable or ameliorable.
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Content ArticleAn evidence review into the scale of the prescribed drug dependence and withdrawal problem in England published by Public Health England (PHE) in 2019 called for support for patients experiencing withdrawal symptoms, including a national 24 hour helpline and associated website. These calls have since been echoed in a recent BBC Panorama episode and other media accounts, but despite the evidence reviews, media interest and public awareness, nothing has changed. This open letter to the Government published in the BMJ calls for specialist NHS services to support patients harmed by taking prescription medications. Signed by healthcare professionals, it highlights that there are still almost no NHS services to support patients who have been harmed by taking medicines as prescribed by their doctor, such as antidepressants and benzodiazepines. The signatories believe that the NHS has a clinical and moral obligation to help those who have been harmed by taking their medication as prescribed, and are urgently calling upon the UK Government to fund and implement withdrawal support services.
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Content ArticleDehydration can be a significant risk to people taking certain medicines. These Sick Day Rules cards aid patients in understanding the medicines they should stop taking temporarily during illness which can result in dehydration, such as vomiting, diarrhoea and fever. They are intended for use as a tool to support conversations between healthcare professionals and patients about their medicines and dehydration.
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Content ArticleThis stocktake by NHS Confederation highlights insights from medicines optimisation forums on the experience of ICS medicines optimisation so far: the opportunities that exist, the barriers experienced, the support that is needed, and what the vision for medicines optimisation could achieve.
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Content ArticleMr Stevenson was a 63-year-old man who was a very respected and experienced Consultant Cardiologist and General Physician at Huddersfield Royal Infirmary, who resigned from his post in May 2022 to enter full retirement. On 6 May 2022 he was referred to the urology department for the investigation of possible prostate cancer, when a decision was also made to consult a private Consultant Urologist. In order to relieve his symptoms of prostatitis and to make him ready for an investigative biopsy, he was prescribed ciprofloxacin on the 19 May. He had no previous history of depression or mental health problems. Subsequently on the morning of 30 May 2022, Mr Stevenson left his home address on his own for his usual walk. He had not previously given any indications to his family for them to be concerned for him. At approximately 12.30pm his wife received a Facebook message from Mr Stevenson to indicate that he had left a note under the pillow of his bed. The note was found to be uncharacteristically confused and illogical given his reference to his baseless concerns that he may have developed AIDs after taking a HIV tester kit he had previously bought on line. Mr Stevenson was found hanging nearby. Upon the arrival of the paramedics, although resuscitative attempts were made, it was confirmed that he had passed away. During the inquest the coroner was referred by Mr Stevenson’s treating urologist to published literature relating to ciprofloxacin and quinolone antibiotics and a potential rare link to suicide behaviour in patients; although it remained unclear that he was suffering from this side effect, it remained possible for this to be the case.
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Content ArticleThe widespread adoption of effective hybrid closed loop systems would benefit people living with type 1 diabetes by improving the amount of time spent within target blood glucose range. Hybrid closed loop systems (also known as 'artificial pancreas' typically utilise simple control algorithms to select the best insulin dose for maintaining blood glucose levels within a healthy range. Online reinforcement learning has been utilised as a method for further enhancing glucose control in these devices. Previous approaches have been shown to reduce patient risk and improve time spent in the target range when compared to classical control algorithms, but are prone to instability in the learning process, often resulting in the selection of unsafe actions. This study in the Journal of Biomedical Informatics presents an evaluation of offline reinforcement learning for developing effective dosing policies without the need for potentially dangerous patient interaction during training.
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Content ArticleMedication error may occur for a variety of reasons. One of the most common sources of medication error is related to look-alike and sound-alike (LASA) drugs as well as the often-similar appearances of the vials. LASA medications are typically thought of as medications that are similar in physical appearance related to packaging as well as medications whose names are similar in spelling or in the phonetic pronunciation. Tricia A. Meyer looks at cases of LASA drugs and prevention techniques. She concludes that healthcare professionals, safety groups, and professional organisations should continue to work with manufacturers, regulators, and naming entities to explore opportunities to minimise the LASA risks for drugs that are either new to the market or in the pre-marketing stage. Further information on the hub Take a look at our Error traps gallery on the hub
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Content ArticleTwo information technology (IT)-based interventions, which aim to improve prescribing safety in primary care, have been rolled out across England over the past few years. Researchers identified five strategies which could help ensure that the systems continue to have an impact over the longer term. The first system (computerised decision support, or CDS) raises a warning when a clinician is about to prescribe a medicine that could increase a patient’s risk of harm. The second method (PINCER) is led by pharmacists; it searches people’s medical notes to identify potential errors that have already happened. Pharmacists, GPs and other clinicians work together to investigate and correct any errors. The research team examined documents, interviewed relevant professionals and carried out workshops which also involved members of the public. They identified strategies that could help ensure that these systems have an ongoing impact in primary care.
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Content ArticleMedicines can be purchased online from anywhere in the world. In 2021, nearly 53 million items were dispensed from online pharmacies in England, up 300% since 2016. In this blog, Dr Georgia Richards outlines the need for caution when buying medicines online, highlighting that online purchase of medications was cited in 16 Prevention of Future Deaths (PFD) reports between 2013 and 2019. She highlights coroners concerns concerns about: the ease of obtaining drugs via the Internet without any contact with the patient’s medical practitioner or access to the patient’s records. the inability to limit the volume or the frequency of ordering. issues with the regulation of supply, importation and delivery of controlled class A drugs via the international and UK postal system. lack of regulation of the dark web.
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Content ArticlePharmacovigilance is the observation and monitoring of possible harms from exposure to a variety of pharmaceuticals, biologics and devices. In this blog, Professor of Evidence-based Medicine Carl Heneghan and Clinical Epidemiologist Tom Jefferson talk about a recent attempt to obtain data on the incidence of deaths following Covid-19 vaccination from the Medicines & Healthcare Products Regulatory Agency (MHRA) through a Freedom of Information request. They describe how the MHRA initially said they were unable to provide the information as it would cost too much to extract, and after sending a follow up request to the MHRA's Chief Safety Officer, they have not heard anything further after an initial promise to investigate. They argue that the MHRA is failing the public by failing to investigate the side effects of Covid vaccines using information from Yellow Card reports. This blog is paywalled once you have read a certain number of articles each month.
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