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Content ArticleThe Department of Health and Social Care is consulting jointly with the Department of Health Northern Ireland to seek your views on amending the Human Medicines Regulations 2012 to enable pharmacy technicians to supply and administer medicines using patient group directions (PGDs). This proposal supports the ambitions of NHS systems across the UK to maximise the use of the skill mix within pharmacy teams, enabling them to meet more of the health needs of their local populations. Deadline: 29 September 2023.
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Content ArticlePeople rely on prescription medication to treat and manage their conditions and keep well. Based on analysis of public feedback from local Healthwatch and from a webform on pharmacies, this blog by Healthwatch England highlights the challenges people face when trying to get prescription medication. It outlines the following key issues: Shortages of medication Delays in getting repeat prescriptions issued Shortages of staff Closed pharmacies
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News Article
Patients feel misled by pledge of cannabis on NHS
Patient Safety Learning posted a news article in News
A high-profile government climbdown which legalised a type of cannabis medicine on the NHS five years ago misled patients, campaigners say. It was thought the law change would mean the unlicensed drug, which treats a range of conditions, could be freely prescribed by specialist doctors. But fewer than five NHS patients have been given the medicine, leaving others to either pay privately or miss out. The government says safety needs to be proven before a wider rollout. Legalisation of whole-cannabis medicine was hailed as a breakthrough for patients - giving either NHS or private specialist doctors the option to prescribe it if they believed their patients would benefit. But patients are being turned away, say campaigners, because doctors often do not know about the medicine, which is not on NHS trusts' approved lists. Some specialists who do know about it say there is insufficient evidence of the drug's safety and benefits to support prescribing. Senior paediatric consultant Dr David McCormick, from King's College Hospital in London, says it was "disingenuous" of the government to suggest in 2018 that NHS prescribing was ready to take place. "Parents were clamouring at our door, or phoning all the time, as they believed we were able to prescribe and that was not the case. "The message went out, 'doctors can now prescribe cannabis products' and that put us in a difficult position, because in truth we need to apply for that to be approved by NHS England." Read full story Source: BBC News, 13 September 2023 -
Content ArticleThe Patient Safety Network (PSNet) produces primers which provide guidance on key topics in patient safety through context, epidemiology and relevant PSNet content. This primer focuses on nurse-related medication administration errors and highlights that despite error reduction efforts through implementing new technologies and streamlining processes, medication administration errors remain prevalent. It covers the background to the issue, low-tech and high-tech prevention strategies and the current context.
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Content ArticleHealthcare professionals prescribing fluoroquinolone antibiotics (ciprofloxacin, delafloxacin, levofloxacin, moxifloxacin, ofloxacin) are reminded to be alert to the risk of disabling and potentially long-lasting or irreversible side effects. Do not prescribe fluoroquinolones for non-severe or self-limiting infections, or for mild to moderate infections (such as in acute exacerbation of chronic bronchitis and chronic obstructive pulmonary disease) unless other antibiotics that are commonly recommended for these infections are considered inappropriate. Fluoroquinolone treatment should be discontinued at the first signs of a serious adverse reaction, including tendon pain or inflammation.
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News ArticleSharri Shaw walked out of the CVS on Vermont Avenue in South Los Angeles in 2019 believing she had a prescription for the pain reliever acetaminophen. Instead the bottle held a medicine to treat high blood pressure, a problem she did not have. Shaw began taking the pills, not learning of the mistake until six days later when a CVS employee arrived at her home, according to a lawsuit she filed last year. The employee told her not to take the tablets, the lawsuit said, before leaving the correct prescription at her door. The mistake, she said, left her stunned. Shaw’s experience is far from an isolated event. California pharmacies make an estimated 5 million errors every year, according to the state’s Board of Pharmacy. Officials at the regulatory board say they can only estimate the number of errors because pharmacies are not required to report them. Most of the mistakes that California officials have discovered, according to citations issued by the board and reviewed by The Times, occurred at chain pharmacies such as CVS and Walgreens, where a pharmacist may fill hundreds of prescriptions during a shift, while juggling other tasks such as giving vaccinations, calling doctors’ offices to confirm prescriptions and working the drive-through. Christopher Adkins, a pharmacist who worked at CVS, and then at Vons pharmacies until March, said that management policies at the big chains have resulted in understaffed stores and overworked staff. “At this point it’s completely unsafe,” he said. Read full story Source: Los Angeles Times, 5 September 2023
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Content ArticleThis debate was requested by Barbara Keeley MP of Worsley and Eccles South, following the death of Emily Chesterton, the daughter of her constituents Marion and Brendan Chesterton. Emily died in November 2022 after suffering a pulmonary embolism. She was just 30 years old when she died. The conclusion of the coroner was: “Emily Chesterton died from a pulmonary embolism, a natural cause of death. She attended her general practitioner surgery on the mornings of 31 October and 7 November 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions. She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived.”
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News ArticleHundreds of people across England with drug and alcohol dependencies who have been prescribed Valium long-term, will have their cases reviewed following an Ombudsman investigation. The Local Government and Social Care Ombudsman has found that Change Grow Live (CGL), on behalf of Cambridgeshire County Council, has been prescribing benzodiazepines to people long-term, against national guidance. The company also provides drug and alcohol services for 50 other councils. Benzodiazepines – including diazepam (Valium) - are a class of medicines that can relieve nervousness, tension and other symptoms of anxiety and should usually only be prescribed short-term. CGL’s policy explains people use them for anxiety, insomnia, to enhance opiate effects, to deal with mental health issues, improve confidence and to reduce psychotic symptoms like hearing voices. However, if they are prescribed for too long, they can have significant negative effects including dependence, withdrawal symptoms and drug-seeking behaviour. People on these medicines should have their prescriptions reviewed regularly, and those reviews should consider the benefits and risks of continuing with the current dose, reducing or stopping it, with a management plan put in place after each review. However, the Ombudsman’s investigation found CGL were either not reviewing people’s prescriptions regularly enough or not keeping proper records of those reviews. Nigel Ellis, Local Government and Social Care Ombudsman Chief Executive, said: “Clinicians need to weigh up the benefits and risks for patients who are taking these medicines long-term and should have a clear rationale for continuing to prescribe. “I am pleased that patients in these vulnerable groups will now have their cases reviewed more regularly and comprehensively following my investigation. “Both CGL and the council have co-operated fully with our investigation, and I welcome their ready acceptance of our recommendations.” Read full story Source: Local Government and Social Care Ombudsman, 23 August 2023
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Content ArticleThe Prescribing Safety Assessment (PSA) is a 60-question exam required as part of UK medical training to progress from FY1 to FY2. This independent review into the PSA was commissioned by the Medical Schools Council (MSC) together with the British Pharmacological Society (BPS) in the summer of 2022. It suggests a strategic future direction for the PSA and addresses how the PSA has impacted prescribing assessment and practice for medical students and Foundation Year 1 (FY1) doctors. It is intended to support national decision making about the future of UK prescribing assessment in the context of the imminent introduction of the Medical Licensing Assessment (MLA).
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News Article
The huge growth in long-term prescription of strong painkillers
Patient Safety Learning posted a news article in News
Almost 180,000 patients have been prescribed strong painkillers every month for two years, a rise of over a third compared to levels recorded just before the pandemic, data obtained by HSJ shows. The figures collected by the NHS Business Services Authority showed 179,353 patients had been prescribed an opioid analgesic every month between April 2021 and March 2023, a 36% increase compared with 131,876 receiving the same prescription between April 2017 and March 2019. Guidelines issued by the National Institute for Health and Care Excellence in 2021 advised clinicians not to prescribe opioids to manage chronic pain. A statement published alongside an earlier draft of these guidelines explained: “While there was little or no evidence that they made any difference to people’s quality of life, pain or psychological distress, there was evidence that they can cause harm, including possible addiction.” In 2020, the Medicines and Healthcare Products Regulatory Agency asked healthcare professionals to discuss the risks of dependency and addiction with any patient taking or planning to take an opioid-containing medicine and made sure such warnings were reinforced in the patient information leaflet. The regulator at the time defined long-term use as longer than three months. Read full story (paywalled) Source: HSJ, 18 August 2023 -
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 ArticleRizwana Dudhia shares in the Pharmaceutical Journal how a project she initiated to prevent the prescribing of inappropriate medication improved the quality of life for patients with learning disabilities and autism.
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Content Article
Better use of data for medication safety in hospitals
Kenny Fraser posted an article in Medicine management
NHS hospital staff spend countless hours capturing data in electronic prescribing and medicines administration systems. Yet that data remains difficult to access and use to support patient care. This is a tremendous opportunity to improve patient safety, drive efficiencies and save time for frontline staff. In this blog, Kenny Fraser, CEO of Triscribe, explains why we need to deliver quick, low-cost improvement using modern, open source software tools and techniques. We don’t need schemes and standards or metrics and quality control. The most important thing is to build software for the needs and priorities of frontline pharmacists, doctors and nurses. -
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 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 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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News Article
NI’s £800m use of prescribed medicines higher than anywhere else in UK
Patient Safety Learning posted a news article in News
Northern Ireland’s chief pharmaceutical officer has said that the use of prescribed medicines and the associated costs remains too high, exceeding £800m a year. In a blog to reflect on the 75th anniversary of the NHS, Professor Cathy Harrison added that medicine costs in NI are the second largest single investment made in the health service, after staff. “The average number of prescription items a year is 21 per person, at a cost of £227. This cost is the highest in the UK and the volume of prescription items is still rising each year,” she said. “There is an uncomfortable truth that manifests in the prescribing data for medicines. In Northern Ireland, we continue to use more of almost every type of medicine than other parts of the UK. “That includes more antibiotics, more painkillers, more baby milks, more nutritional supplements, even more oxygen.” Read full story Source: Belfast Telegraph, 27 June 2023 -
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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EventuntilThis conference focuses on social prescribing in England, assessing progress and discussing next steps. This Westminster Health Forum will be an opportunity to examine the impact and cost-effectiveness of social prescribing so far, ahead of the review of the Additional Roles Reimbursement Scheme in general practice taking place in early 2024. Delegates will discuss the developing role of social prescribing in tackling loneliness and prescribed medicine dependence, support with cost of living pressures and health inequalities, and in improving access to green spaces. It will also be an opportunity to discuss priorities for developing social prescribing programmes and how these can access new groups - including schools, prisons and veterans - following the National Academy for Social Prescribing being awarded funding to continue supporting people to access innovative mental health support. Further sessions examine the next steps for the social prescribing workforce, including challenges around pay, pressure and capacity, as well as issues with training and support for dealing with complex conditions, and the role of link workers and colleagues in addressing wider challenges in primary care. Overall, areas for discussion include: looking forward: next steps and the longer-term outlook for social prescribing - building the workforce to meet demand - developing local community healthcare partnerships integrated care: operating in new ICS structures - developing prevention initiatives - the role of social prescribing in addressing pressures in primary care workforce: priorities and challenges for expansion - opportunities for funding and training - engaging the voluntary sector in light of increased pressure on the NHS cost-effectiveness: latest research and thinking on the efficacy of social prescribing - assessing progress on cost savings in the NHS and expectations for the scale and timing of tangible impacts widening delivery: next steps for accessing new groups such as schools, prisons and veterans - utilising funding - developing personalised patient care health inequalities: opportunities for further outreach initiatives - reaching communities who have the greatest inequalities - best practice in creating trusted relationships. Register
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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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News Article
Ministers failing to reform ‘restrictive’ primary care rules
Patient Safety Learning posted a news article in News
The government has failed to change ‘restrictive’ legislation which would enable primary care reform – despite repeated announcements – a pharmacy leader has said. Currently, pharmacy technicians cannot take on dispensing tasks without supervision from a pharmacist but the government promised in 2019 to look at how legislation can be updated to allow pharmacy technicians to take more of a role in dispensing, as part of the current five-year Community Pharmacy Contractual Framework, which ends next year. The government has repeatedly announced and reannounced over the past five years that it wants to remove restrictions to give community pharmacy an expanded role. But in a new report shared exclusively with HSJ, the Company Chemists’ Association – the trade body with members including Asda, Boots, Lloyds Pharmacy and Superdrug – highlights that government has failed to make progress. Read full story (paywalled) Source: HSJ, 7 June 2023 -
News Article
Plan for GPs to offer NHS patients weight-loss jab
Patient Safety Learning posted a news article in News
GPs in England may start offering weight-loss jabs to some patients to reduce obesity-related illnesses and resultant pressure on hospitals. Wegovy was approved for NHS use after research suggested users could shed over 10% of their body weight. The drug blunts appetite, so users feel full and eat less. Rishi Sunak said it could be a "game-changer" as he announced a £40 million pilot scheme to increase access to specialist weight management services. But experts warn "skinny jabs" - widely used in the US and endorsed by many celebrities - are not a quick fix or a substitute for a healthy diet and exercise. NHS drugs watchdog, the National Institute for Health and Care Excellence (NICE), says patients can access Wegovy for a maximum of two years via specialist weight-management services. The new scheme will test how GPs could safely prescribe such drugs and the NHS provide support in the community or digitally, contributing to the government's wider ambition to reduce pressure on hospitals and give patients access to the care they need where it is most convenient for them. Read full story Source: BBC News, 7 June 2023 -
Content ArticleEngland is the only country in the UK to still charge patients for prescriptions, with charges having been abolished in Wales and Scotland in 2007 and 2011, respectively. However, for patients in England, the cost is rising; in March 2023, the government announced an inflationary increase of 3.21%, bringing the prescription charge up to £9.65. And the number of people eligible to pay could increase, following government proposals to raise the upper age exemption for free prescriptions from 60 to 65 years. This article looks at the impact of prescription charges on health inequalities, particularly focusing on the impact of the cost of living crisis. The reporter speaks to pharmacists who regularly see patients making difficult choices about which prescriptions to collect, as well as highlighting research that suggests many patients with long term conditions are forgoing their medications as they cannot afford them.
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News Article
FDA proposes revamping medication guides that come with prescriptions
Patient Safety Learning posted a news article in News
The US Food and Drug Administration has proposed to add to what you get with your prescription drugs. The proposed rule would require the prescriptions you get to come with a new kind of single-page medication guide with an easy-to-use set of directions and easy-to-understand safety information, a goal the FDA has been working toward for years. One study found that nearly 75% of Americans have had trouble taking their medicine as directed. A lot of that is due to cost – people might not be able to afford their medicine, so they don’t take it – but some is due to confusion. They might get more than one kind of written information with their prescription, or the information they receive can be conflicting, incomplete or repetitive, the FDA said. When people are confused or misinformed about their prescription, there is a good chance they will not take it or will stop taking it, and that can directly hurt their health. “Research suggests that medication nonadherence can contribute to nearly 25% of hospital admissions, 50% of treatment failures, and approximately 125,000 deaths in our country each year,” the FDA says. The agency said the new proposal is also meant to help fight the “nation’s crisis with health care misinformation and disinformation.” Read full story Source: CNN, 30 May 2023 -
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.
