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a pharmacist dispensary shelves imageFebruary 26 2018

The Government has been advised to instigate a wide-ranging programme of action to tackle medication error and improve medicine safety. 

Included in a swathe of recommendations are calls to:

  • improve availability and sharing of patient information between different care settings;
  • equip patients and the carers with better information and encouraging them to ask about their medication;
  • improve training and education around medicines in health profession undergraduate and post-registration training;
  • improve the packaging of medicines, and to look at how medicines are named;
  • roll-out proven interventions in primary care such as PINCER (Pharmacist-Led Information Technology Intervention for Reducing Rates of Clinically Important Errors in Medicines Management in General Practices);
  • share best practice more effectively;
  • better monitor and assess medicines errors, and research into how errors can be further reduced.

The recommendations have been made by the Short Life Working Group on reducing medication-related harm. This was set up in September 2017 with a remit to advise the Government on the scope of a programme to improve safety in the use of medicines, including how to reduce medication errors and establish the best way to measure progress.”

Its report has been published on the same day as new research has been published by the Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU), which was asked to review the evidence on medication errors in England.

Data from this 174-page study has been picked up in the national media with claims that:

  • an estimated 237 million medication errors occur at some point in the medication process in England per year (of which 72% have little/no potential for harm);
  • an estimated 66 million potentially clinically significant errors occur per year, 71.0% of which are in primary care;
  • prescribing in primary care accounts for 33.9% of all potentially clinically significant errors;
  • non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulants and antiplatelets cause over a third of hospital admissions due to avoidable adverse drug reactions (ADRs);
  • primary care ADRs leading to a hospital admission were estimated to cost the NHS £83.7 million and cause 627 deaths and contribute to 22,303 deaths;
  • secondary care ADRs leading to a longer hospital stay were estimated to cost £14.8 million, cause 85 deaths and contribute to 1,081 deaths;

“It is likely that many errors are picked up before they reach the patient, but we do not know how many,” said the researchers from the Universities of Manchester, York and Sheffield. They compiled the review analysing 36 studies.

The document notes: “There is little evidence about how medication errors lead to patient harm,” and that the researchers had to estimate burden using studies that measured harm from ADRs.

In addition, “estimates are based on studies at least 10 years old so may not reflect current patient populations or practice.” However, “this may be an underestimate of burden as only short-term costs and patient outcomes are included, and we had no data about the burden of errors in care homes.”

Health Secretary Jeremy Hunt flagged up both papers in a speech at the Annual World Patient Safety, Science & Technology Summit in London on February 23. He said that measures being taken currently that should improve openness and transparency in detecting, reporting and addressing medication errors include:

  • the decriminalisation of dispensing errors, due to come into effect from April,
  • starting to better understand the level of hospital admissions arising from prescribing in primary care
  • increasing uptake of electronic prescribing in hospitals.

Responding to the reports, Professor Helen Stokes-Lampard, RCGP Chair, said: “GPs already use systems designed to help them prescribe safely, but the College would welcome any additional resources or technology that will help to further minimise the risks of making a medication error, such as those outlined by the Health and Social Care Secretary today. Systems better linking prescribing data in primary care to hospital admissions, sound like a particularly good and necessary step forward.

“What is essential, is that highlighting that prescribing errors do occasionally happen is not used to admonish hardworking NHS staff – including GPs – for making genuine mistakes, but to address the root cause, and in general practice that is intense resource and workforce pressures, meaning that workloads and working hours are often unsafe for GPs and our teams.”

BMA GP committee chair Dr Richard Vautrey added: “While the vast majority of prescribing is carried out to a high standard, adverse incidents can still occur. The NHS needs to learn from these instances, and we hope these plans will lead to improved systems in hospitals and community settings that reduce the possibility of errors as much as possible.

“GP practices are facing increasing demand on their services, with patients presenting with increasingly complex health problems, so the Government needs to continue to work with us to establish a workforce strategy including enabling practices to expand their multi-disciplinary team to help meet patients' needs.”

Links:

DHSC announcement    https://www.gov.uk/government/publications/medication-errors-short-life-working-group-report

DHSC. ‘The Report of the Short Life Working Group on reducing medication-related harm’. February 2018             https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/683430/short-life-working-group-report-on-medication-errors.pdf

EEPRU report. R Elliott et al. ‘Prevalence and Economic Burden of Medication Errors in The NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK’. Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York. 2018           http://www.eepru.org.uk/article/prevalence-and-economic-burden-of-medication-errors-in-the-nhs-in-england/

RCGP statement           http://www.rcgp.org.uk/news/2018/february/college-welcomes-patient-safety-measures-on-prescribing.aspx

BMA statement            https://www.bma.org.uk/news/media-centre/press-releases/2018/february/bma-responds-to-medication-errors-patient-safety-review

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