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News Article
Prescribing antidepressants for chronic pain lacks evidence, experts say
Patient Safety Learning posted a news article in News
Researchers have warned there is a lack of evidence around prescribing antidepressants for chronic pain. Guidance from the National Institute for Health and Care Excellence (Nice) in 2021 recommends that an antidepressant (amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline) can be considered for people aged 18 and over with pain lasting longer than three months which cannot be accounted for by another diagnosis. The guidance said the drugs may help with quality of life, pain, sleep and psychological distress, even if the patient is not suffering depression. A separate guideline on neuropathic (nerve) pain recommends offering a choice of treatments, including amitriptyline and duloxetine, alongside a discussion on possible benefits and side-effects. However, researchers writing in the BMJ have warned that recommending antidepressants for pain is not always backed by evidence. Professor Martin Underwood from the University of Warwick, said: “There is a role for antidepressants in helping people living with chronic pain, however, this is more limited than previously thought. “Antidepressants may have unpleasant side effects that patients may wish to avoid. “We need to work harder to help people manage their pain and live better, without relying on the prescription pad.” Read full story Source: The Independent, 1 February 2023 -
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Event
Next steps for pharmacy in healthcare delivery in England
Patient Safety Learning posted a calendar event in Community Calendar
untilThis Westminster Health Forum conference will focus on next steps for pharmacy services in healthcare delivery, and opportunities to develop the role of community pharmacy as part of the health service in England. It comes amidst proposals to increase prescribing powers for pharmacists and reform training to enable pharmacists to work as independent prescribers immediately following graduation, as well as the Health Secretary announcing additional pharmacy services within the Primary Care Recovery Plan, and also indicating that implementation of a Pharmacy First system in England is being considered. The conference takes place against the backdrop of an evolving healthcare landscape, including developments in integrated care systems and digital transformation, an expected update to the NHS Long Term Plan, and wider strategic initiatives to implement alternatives to medicine, such as the Overprescribing Review. We expect discussion on opportunities to develop pharmacy services as a key component of future NHS and community care delivery. It will include keynote sessions with Gisela Abbam, Chair, General Pharmaceutical Council; Andrew Lane, Chair, National Pharmacy Association; Matthew Armstrong, Senior Manager, Pharmacy Contracts and Project Developments, Walgreens Boots Alliance; and a senior speaker confirmed from the Professional Record Standards Body. Overall, areas for discussion include: strategic ambitions: the opportunity for a Pharmacy First scheme in England - long-term aims for pharmacy services in the context of an updated NHS Long Term Plan. community pharmacy: future role in improvements to key service areas such as general practice, primary care and the ambulance service - delivering medicine optimisation in community care. the workforce: priorities for upskilling - improving training to increase the number of independent prescribers and develop the services that pharmacists can offer. digital pharmacy: key areas for expansion - supporting efficiency in prescription management - potential for digital services to allow patients more control over their care. further development areas: social prescribing services and non-medical treatments - the NHS STOMP programme - structured medicine reviews to support reduction of overprescribing. Register -
News Article
Older patients on medley of drugs ‘at higher risk of adverse reactions’
Patient Safety Learning posted a news article in News
Older women are at higher risk than older men of experiencing adverse reactions to drugs prescribed by their family doctor, and older patients taking more than 10 medicines are at higher risk than those taking fewer, according to a study. Overall, one in four older people experience adverse drug reactions (ADRs) to pills prescribed by their GP, the research published in the British Journal of General Practice suggests. It has prompted calls for GPs to consider deprescribing ineffective medications and prioritise patients taking lots of drugs for a regular review of their prescriptions. The medicines most commonly associated with ADRs included those used to treat high blood pressure and other cardiac conditions, strong painkillers such as tramadol, and antibiotics such as amoxicillin, according to the study. The study monitored 592 patients aged 70 and older across 15 general practices in the Republic of Ireland over a six-year period. One in four experienced at least one ADR. Patients prescribed 10 or more medicines had a threefold increased risk of experiencing a reaction, researchers said. Women were at least 50% more likely to have ADRs than men, the study found. “ADRs can be difficult to identify in medically complex older adults as they often present as non-specific symptoms,” the researchers wrote in the British Journal of General Practice. “GPs are well placed to detect the occurrence of ADRs from drugs prescribed in primary care as well as in other care settings. Deprescribing of ineffective medications and those no longer clinically indicated is one approach to reducing the risk of ADRs in older patients.” Read full story Source: The Guardian, 24 January 2023 -
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News ArticleHigh risks relating to the ordering, prescribing, storing and administration of medicines have been found by the Mental Health Commission in a series of inspections of mental health centres in Dublin. The commission emphasised the need to have appropriate practices including the recording of the minimum dose interval information; where medication has been stopped, the stop date to be recorded; and the need to always have the prescriber’s signature recorded. The inspector of mental health services Dr Susan Finnerty said it was positive to see centres maintaining high compliance rating, but spoke of concerns around the administration of medication. “We know that medication is an important tool in treatment of mental illness. In order to reduce the risk of medication errors, we need to be sure that medication prescription and administration records are completed correctly,” Dr Finnerty said. Read full story Source: Independent Ireland, 18 January 2023
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Green Health Routes (NHS Forest, December 2022)
Patient_Safety_Learning posted an article in Social prescribing
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News Article
Antidepressants ‘should be reduced in stages’ to avoid withdrawal symptoms
Patient Safety Learning posted a news article in News
GPs whose patients want to stop taking antidepressants should reduce the dose of their medication in stages to lower the risk and severity of withdrawal symptoms, the medicines watchdog has said. About one in six (16%) adult Britons experience moderate to severe depression, according to the Office for National Statistics. In England alone, 21.4m antidepressant drugs were prescribed between July and September 2022, according to the NHS Business Services Authority. A new draft quality standard for the care of adults with depression from the National Institute for Health and Care Excellence (NICE) – the first update in 11 years – includes specific guidance to help adults come off antidepressant medication permanently. NICE’s independent advisory committee, which includes experts in treating adults with depression, recommends the staged withdrawal of antidepressants in patients who want to stop taking the drugs. A staggered reduction of medicine, known as tapering, helps to reduce withdrawal effects and long-term dependence on the medication, according to Nice. The committee said primary care and mental health professionals should follow the NICE guideline recommendations on stopping antidepressant medication, including agreeing with their patient whether it is right for them to stop taking the medication and, if so, the speed and duration of withdrawal from it. Read full story Source: The Guardian, 17 January 2023 -
News ArticleThe UK needs to do more to use diagnostic testing in the fight against antimicrobial resistance (AMR), the chair of a government-commissioned review on AMR told MPs. Lord O’Neill, an economist and former treasury minister, warned in the review’s final report in 2016 that a continued rise in AMR would lead to 10 million people dying each year by 2050 and made ten recommendations, including the need for rapid diagnostics to reduce unnecessary use of antimicrobials. Speaking to a Commons Science and Technology Committee evidence session on 22 June 2022, Lord O’Neill said that while he was pleased with progress on some of the recommendations published in his review in 2016, especially in the reduction of antimicrobials in agriculture, progress on diagnostics was “woeful”. He said it was “alarming to me how we are not embedding state-of-the-art diagnostic technology right in the middle of our health systems”, adding that it could “really make a huge difference about whether an antibiotic is needed or not, and the right kind of antibiotic”. “Our most aggressive recommendation was that we should ban the use of subjective prescriptions in secondary settings, at least in Western countries, until they’ve gone through a state-of-the-art diagnostics,” he continued. “And nobody’s done it; they claim it’s a vicious circle, the technology isn’t there, but we have to give incentives in order to get this embedded because that would make a permanent difference.” Read full story Source: The Pharmaceutical Journal, 24 June 2022
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News Article
Superbug ‘pandemic’ stalks India as antibiotic resistance jumps 10% in a year
Patient Safety Learning posted a news article in News
India faces a “pandemic” of superbugs, the country’s top public health experts have warned, as resistance to common antibiotics has jumped by 10% in just one year In the fifth edition of its annual report on antimicrobial resistance (AMR), the Indian Council of Medical Research warned that urgent action is needed to prevent a major health crisis caused by the rampant misuse of antibiotics. “The resistance level is increasing to five to ten per cent every year for broad spectrum antimicrobials, which are highly misused,” said Dr Kamini Walia, who led the ICMR’s report. “Antibiotic resistance has the potential of taking the form of a pandemic in the near future if corrective measures are not taken immediately.” The report warned that only 43% of pneumonia infections in India could be treated with first line antibiotics in 2021 – down from 65% in 2016. “We could absolutely see a pandemic driven by AMR infections in India,” said Ramanan Laxminarayan, director of the One Health Trust, a global public health think tank. “It is certainly within the realms of possibility, it could be next year or over the next two decades. “Bacterial infections were the biggest killers in the early 20th Century and we risk going back to that time where there are no effective antibiotics and infections can spread rapidly,” he added. Read full story (paywalled) Source: The Telegraph, 16 September 2022 -
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News Article
People in UK turning to DIY health treatment amid shortage of GP appointments
Patient Safety Learning posted a news article in News
Almost one in four people have bought medicine online or at a pharmacy to treat their illness after failing to see a GP face to face, according to a UK survey underlining the rise of do-it-yourself treatment. Nearly one in five (19%) have gone to A&E seeking urgent medical treatment for the same reason, the research commissioned by the Liberal Democrats shows. One in six (16%) people agreed when asked by the pollsters Savanta ComRes if the difficulty of getting an in-person family doctor appointment meant they had “carried out medical treatment on yourself or asked somebody else who is not a medical professional to do so”. Ed Davey, the leader of the Liberal Democrats, said delays and difficulty in accessing GP appointments constituted a national scandal, and face-to-face GP appointments had become “almost extinct” in some areas of the country. He said: “We now have the devastating situation where people are left treating themselves or even self-prescribing medication because they can’t see their local GP.” Dr Richard Van Mellaerts, the deputy chair of the British Medical Association’s GP committee in England, said: “While self-care and consulting other services such as pharmacies and NHS 111 will often be the right thing to do for many minor health conditions, it is worrying if patients feel forced into inappropriate courses of action because they are struggling to book an appointment for an issue that requires the attention of a GP or a member of practice staff.” Read full story Source: The Guardian, 2 January 2023 -
News Article
Private menopause clinics prescribing HRT at 'twice the recommended dose'
Patient Safety Learning posted a news article in News
Private menopause clinics are prescribing HRT at "twice the recommended dose", an investigation has revealed. The investigation by The Pharmaceutical Journal has revealed that patients attending private menopause clinics are subject to “unorthodox prescribing” by providers. Many are receiving oestrogen at up to double the recommended dose placing them at higher risk of cancer and vaginal bleeding. Nuttan Tanna, a pharmacist consultant in women’s health at London North West University Healthcare NHS Trust, said she had seen referrals for “bleeding investigations” and then found the patient was on "very large doses [of oestrogen] prescribed previously by private providers”. Brendon Jiang, a senior clinical pharmacist for North Oxfordshire Rural Alliance Primary Care Network, said that his team were increasingly getting letters from private clinics requesting for patients to be prescribed doses of oestrogen that are off-label or exceed licensed recommendations. He also raised concerns that patients were not taking enough progesterone alongside increased doses of oestrogen. Taking increased doses of oestrogen alone can increase the risk of womb cancer but progesterone protects against that risk and therefore the two hormones should be taken together. Read full story (paywalled) Source: The Telegraph, 19 December 2022 Further reading on the hub: Surgical menopause: a toolkit for healthcare professionals (British Menopause Society) Menopause Support - Getting the most out of your doctor’s appointment World Menopause Day 2022: Raising awareness of surgical menopause All-Party Parliamentary Group on Menopause: Inquiry to assess the impacts of menopause and the case for policy reform - conclusions -
News ArticleMedicine shortages are an “increasing problem” for Australia and antibiotics are among the commonly prescribed drugs currently in short supply, the peak body for general practitioners says. The drugs regulator, the Therapeutic Goods Administration (TGA), said the three most commonly prescribed antibiotics – amoxicillin, cefalexin and metronidazole – are scarce. They are used to treat a range of bacterial infections, including pneumonia and other chest infections, skin infections and urinary tract infections. To see patients through the shortage, the TGA has authorised pharmacists to provide alternative antibiotics without approval from the prescribing doctor. “Importantly, many of these medicines have alternatives available,” the TGA said. “Your pharmacist may be able to give you a different brand, or your doctor can prescribe a different strength or medicine with similar spectrum of activity.” A TGA spokesperson said “most of the antibiotic shortages are caused by manufacturing issues or an unexpected increase in demand”. Dr Nicole Higgins, the president of the Royal Australian College of General Practitioners, said the shortage of certain medicines was “becoming an increasing problem in Australia”. Read full story Source: The Guardian, 12 December 2022
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Content ArticleThe urgent need to reduce the serious harms of overuse in healthcare led to a global movement, Choosing Wisely, launched in the United States in 2012 and now active in more than 30 countries across six continents, including the UK. Choosing Wisely campaigns are national grassroots efforts, led by clinicians in partnership with patients, other clinicians, and professional societies. They provide evidence based recommendations about changes to practice and develop tools to help clinicians implement those recommendations in partnership with patients.
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Each NHS Trust and local pharmacies in Dorset have been promoting awareness and providing updates for staff and patients on medications without harm and medicines safety following World Patient Safety Day in September. On Monday 17 October we held a face-to-face event to share learning from medicines incidents and to specifically focus on the safety improvement programme to reduce harm from opiate drugs in our communities. This provided an excellent opportunity to network with other healthcare professionals. Speakers on the day were: Head of Medicines Improvement at NHS Dorset who set the scene for the morning with facts and figures for discussion. Clinical Lead for the Wessex Academic Health Science Network Polypharmacy programme provided an update on the wider safety improvement work. Patient Safety Specialist with NHS Dorset presented a patient story of a person that died following accidental fatal intoxication with liquid morphine. Deputy Chief Pharmacist at Dorset County Hospital (DCH) and long serving Medicines Safety officer in Dorset shared the improvement work that has taken place in DCH in relation to opiate prescribing on discharge. Dr Sarah Kay, GP lead for Patient Safety with NHS Dorset, concluded the morning with a facilitated discussion session to share best practice and consider how organisations can work together to improve medicines safety. Attendees included Primary Care Network (PCN) pharmacists, hospital trust pharmacists, NHSD patient safety teams, medicines optimisation team, primary care team, AHSNs. In Dorset we prescribe almost double the volume of liquid opioids to patients in our hospitals when compared with others in our region. This increases the risk of prolonged prescribing in primary care, which can lead to long-term tolerance and dependency, and contributes to nearly 700 patients requesting multiple liquid opioid prescriptions each month for chronic non-cancer pain. This prescribing is having a disproportionate impact on women between 40 and 60 years of age and in more deprived areas of our county. At the event, we heard from some acute trusts and PCN colleagues who are having success in reducing opiate usage and promoting safe pain management strategies for people, as well as from the Wessex AHSN who can support ongoing improvement programmes. The morning was compered by NHS Dorset Patient Safety Partner (volunteer lay role) Simon Wraw who ensured the patient perspective was part of our discussions. The opportunity to meet face to face with colleagues was really valuable, as well as making new counterpart connections for each professional group. Feedback from attendees was positive and we hope to run a similar event in the future with a different topic focus. On the topic of networking, we have also contributed to the setup of the NHSE South West GP Quality Network. A scoping meeting was held in October to co-produce a plan for the network with participants. We hope to build the network, so if you work in any patient safety role across the South West and have an interest in general practice and connecting with colleagues to share good ideas and troubleshoot problems together please get in touch. The next network meeting will be 22 February 2023. Please email england.swqualityhub@nhs.net for an invite. Further reading See our recent Patient Safety Spotlight interview with Sarah and Jaydee. -
Content ArticleThe white paper outlines the Alliance for the Digitalisation of Medication Management in European Hospitals’ calls for action, providing examples from across of the European Union of digitalisation of the pathway. The calls for actions include: Implement digital systems in hospitals for the effective employment of the European Shortages Monitoring Platform. Enhance patient safety and hospitals’ pharmaceutical systems resilience by digitalising hospital´s medication management pathways. Support hospitals to scale up and update their IT infrastructure. Provide sustained funding to scale up digital medication management. Develop healthcare professionals’ digital skills and provide trained experts to support change management in hospitals. Standardise and include medication treatment data from ambulatory care and hospitals in the European Health Data Space.
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News Article
Michael Watt: Review finds 'significant failures' in patient treatment
Patient Safety Learning posted a news article in News
A review of the clinical records of 44 patients who died under the care of former neurologist Michael Watt has found "significant failures in their treatment" and "poor communication with families". While this review looked at a sample of cases in which people died, potentially thousands more could be affected. The review arises from a 2018 recall of 2,500 outpatients who were in Dr Watt's care at the Belfast Health Trust. About one in five patients had to have their diagnoses changed. This separate review into 44 deaths was conducted by the Royal College of Physicians at the request of the regulator, the Regulation and Quality Improvement Authority (RQIA). It highlighted concerns over clinical decision-making, prescribing and diagnostics. It reveals a misdiagnosis rate of 45% among this group of patients, twice that for living patients. Speaking to BBC News NI, the RQIA's chair, Christine Collins, said the outcome of the review was "shocking and gut-wrenching as so many had experienced unpleasant deaths which they ought not to have done". Read full story Source: BBC News, 29 November 2022 -
Event
SMASH GM Dashboard – Launch event webinar
Patient Safety Learning posted a calendar event in Community Calendar
untilThe new and re-developed SMASH Dashboard is now ready for rollout across Greater Manchester. The Safety Medication Dashboard (SMASH) has been developed and tested by GM PSTRC researchers. It builds on the same prescribing indicators as PINCER and is a pharmacist-led intervention using audit and feedback. In this 1-hour webinar, we will showcase the new dashboard which utilises the GMCR BI Analytics Platform and provide an overview on how it works, and how it differs from the current platform. We will share the journey the SMASH has been on to this point, and the benefits it will now bring to the GM system. Details will also be provided on how to access and set up accounts, and the local processes to follow. We will have guest speakers on the day from across all of the SMASH journey and an opportunity, if time, to answer some questions. Agenda Outline: Introduction The SMASH Journey The New Dashboard and Tutorial Benefits of the New Platform Access and Processes for Your Locality Q & A Register -
Content ArticleBased on initial system requirements, Williams et al. designed the dashboard’s user interface over three iterations with six GPs, seven pharmacists and a member of the public. Prescribing safety indicators from previous work were implemented in the dashboard. Pharmacists were trained to use the intervention and deliver it to general practices. A web-based electronic dashboard was developed and linked to shared care records in Salford, UK. The completed dashboard was deployed in all but one (general practices in the region. By November 2017, 36 pharmacists had been trained in delivering the intervention to practices. There were 135 registered users of the dashboard, with an average of 91 user sessions a week. The authors have developed and successfully rolled out of a complex, pharmacist-led dashboard intervention in Salford, UK. System usage statistics indicate broad and sustained uptake of the intervention. The use of systems that provide regularly updated audit information may be an important contributor towards medication safety in primary care.
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News Article
Patients prescribed heating as part of health trial
Patient Safety Learning posted a news article in News
Doctors are prescribing heating to patients with conditions that get worse in the cold as part of a health trial. The Warm Home Prescription pilot paid to heat the homes of 28 low-income patients to avoid the cost of hospital care if they became more ill. Michelle Davis, who has arthritis and serious pulmonary illness, had her energy bills paid for and said the difference was "mind-blowing". "When the weather turns cold, I tend to seize up," she told the BBC. "It's very painful, my joints ache and my bones are like hot pokers." In 2020 Ms Davis spent most of the winter in bed, trying to keep warm and was admitted to hospital with pneumonia and pleurisy. But not in winter 2021. "You're not stuck in bed, you're not going to hospital, my children were able to have a life, they were able to go out and play and get cold," she said. Academics estimate that cold homes cost NHS England £860m a year and that 10,000 people die every year due a cold home. But that research was completed before the current cost of living crisis took hold. This first trial achieved such good results, that it's being expanded to 150 households in NHS Gloucestershire's area, plus about 1,000 in Aberdeen and Teesside. Dr Matt Lipson helped design the pilot programme and feels like this preventative step is a no-brainer for the health service. "If we buy the energy people need but can't afford, they can keep warm at home and stay out of hospital," he said. "That would target support to where it's needed, save money overall and take pressure off the health service." The change in patients was swift: "The NHS were telling us they were seeing a benefit much more quickly than pills and potions," Dr Lipson added. "It was taking days, not weeks and months." Read full story Source: BBC News, 22 November 2022 -
News Article
Oklahoma proposes landmark rule to keep mailed medications safe
Patient Safety Learning posted a news article in News
Patients in Oklahoma, USA, who get their prescription medications by mail may soon have better protections for the safety of those drugs than any other state. On Wednesday, Oklahoma regulators proposed the nation’s first detailed rule to control temperatures during shipping, according to pharmacy experts. “This is a huge step,” said Marty Hendrick, executive director of the Oklahoma State Board of Pharmacy, after the board voted to approve the rule Wednesday. “We’ve got a tremendous amount of prescriptions that get mailed to patients. … What we did today was make sure our patients in Oklahoma are receiving safe products.” Exposure to extreme temperatures can degrade or weaken drugs, potentially changing their dosage or chemical makeup and rendering them ineffective or unsafe for patients. But while government oversight of how pharmacies store medications to keep them in defined safe temperature ranges is very detailed, an NBC News investigation in 2020 found oversight of shipping to patients — during which drugs might be exposed to heat waves and below-freezing temperatures — is largely a system of blind trust. Mail-order pharmacy is a booming business, with soaring profits for some of the nation’s largest companies last year and more than 26 million people receiving their medication by mail in 2017 — more than double the number two decades earlier, according to federal data. NBC News found that most state pharmacy boards, the regulators responsible for pharmacy safety, did not have specific rules for how pharmacies should ship customers’ medication, few asked about this process in their inspections, and many said it was simply up to the pharmacy to ensure safe shipping. Read full story Source: NBC News, 17 November 2022 -
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