Medication safety by Dr Neelam Dhingra
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his year's Patient Safety Day is dedicated to the theme of “Medication Safety” and calls for action to achieve no medication harm. To move forward, collaborative efforts, creativity, and innovation are the key components. Moreover, to accelerate, we need to ensure that we stick to medication safety practices. We have created a social movement for medication safety, including all the stakeholders from the grassroots to the policymakers, along with the government.
THE PROBLEM
As per the WHO reports, the patient safety flag is flying high, whereas the safety of the medication for the patient is still a matter of question. We presume that patients know everything about what is going on and will be taken care of. Patients do not know everything about healthcare, but at the very basic level when patients seek healthcare, they never expect to be harmed.
However, we witness a huge burden of patient harm, that is avoidable by practising safe medical care. This is where our attention should be diverted. Medication issues are very prominent at the patient level because almost 50% of this harm comes from self-medication and there is no way we can intervene in this, except to educate the patients. The other half of patient harm due to medication issues is due to incorrect medication prescription and administration. These are all avoidable, and we have a huge number of suffering patients and families because of us not addressing this avoidable cause.
THE STATISTICS
About one in 20 patients suffer avoidable medication harm. One-fourth of these harms are severe and potentially life-threatening. Medications that have been implicated might affect the central nervous system (CNS) and cardiovascular systems and are relatively riskier. It has been reported that there’s an increasing trend for the prevalence of avoidable medication harm occurring in elderly patient care units, intensive care units (ICU), highly specialized surgical care, and emergency departments. A plethora of reports has shown that 0.7% of the total global expenditure, or $42 billion worldwide, can be saved if medication errors are prevented. Globally, it has been divided into two stages: the prescribing stage and the monitoring stage. Most prescribing errors and nearly half of the monitoring errors are avoidable.
However, it has been observed that sometimes patients also make errors, and as per the reports, there is less research on the patient’s errors compared to errors that occur due to the interaction between healthcare workers. However, the frequency of patient error in self-medication is between 19% and 59%, and patients also suffer because of their errors in 26% of cases.
It is very important to keep in mind that it is the responsibility of the healthcare system to provide an enabling environment and a safety culture.
INCULCATING SAFETY
In addition, the HCWs need to understand the importance of a safety culture so that they can openly discuss risk issues, learn from errors, and also prevent harm. The interaction between healthcare workers and patients is the one that is crucial, and everybody has an important role in that interaction to prevent the risk of harm.
To cope with the issue, the W.H.O. launched a global patient safety challenge in 2017 with the intention of reducing avoidable harm. This challenge was launched at the ministerial summit in Germany in 2017. And since then, there have been several initiatives. The W.H.O. provided a strategic framework to shape this challenge, which identifies the main problem areas that need to be addressed as part of a systems approach.
The major domains include patients and the public, medicines and healthcare workers, and lastly, systems and medication practices. Thus, it is important to develop a strategic framework that identifies the key areas or key dimensions that must be put in place to address and mitigate medication-related harm. And it is very important to gather the data from the countries and inform them to focus their attention on the situation of polypharmacy and transitions of care.
WHO has also developed several technical reports in the various associated areas for patient engagement, like ‘five moments’ when actions by patients and families can significantly reduce harm. We have medication safety norms in different formats on a mobile app. This app is an essential tool for ongoing engagement with patients and their families and healthcare workers.
Similarly, WHO has developed an essential series of technical products for safer primary care. Medication error is only one of the modules in this technical series. Over time, WHO also developed modules for reporting and learning systems for medication errors, the role of pharmacovigilance centres, and a patient safety reporting alerting system. Thus, the important aspect here is to make people understand how these systems should come together to capture the errors and look at the learning progress.
Recently, a report was released discussing the implications of a global pandemic for patient safety, which specifically looked into issues of medication safety and the risks due to medication.
Some newer projects and programs have been initiated, which we are taking forward, including the “Know Check Ask” campaign, patient and family engagement, monthly webinars on medication-related harm, a medication safety curriculum, a medication safety solution to address the vulnerable population, and a global event on September 15 to mark the day as the global event for patient safety. It was believed that the interaction between health workers and patients is something we should work on. And this year’s campaign, through the “Know Check Ask” campaign, has helped that interaction.
GOING FORWARD
The multiple projects available in the remaining months of 2022 include medication without harm, medication safety for look-alike and sound-alike medicines, and medication safety in maternal and newborn care. Another important aspect to address is asking countries and policymakers to prioritize medication safety and medication without harm and help reduce the global burden of preventable medication-related harm in health care.
It is believed that World Safety Day this year, dedicated to medication safety, will help us globally to consolidate it. The need of the hour is to take action focused at a national level, asking countries to prioritize and effectively manage three key areas to protect patients from harm, namely: high-risk situations, polypharmacy, and transitions of care. Moreover, there are programs developed at the country level on medication safety for sustainability, which is based on actual assessments. And our team has designed targeted programs to change, particularly in the four domains of the challenge framework, which include patients and the public, medicines, healthcare workers, and lastly, the system and practices of medication.
I believe that the Global “Patient Safety Action Plan 2021–2030,” which was adopted by the World Health Assembly last year, would provide the framework for countries to take forward sustainable action concerning medication without harm, which is one of the strategies embedded in the objectives of safe clinical processes.
Having a framework for countries to report will go a long way in demonstrating the impact of the challenge of medication safety and the impact of the word “patient safety.” And every two years from now on, the W.H.O. is going to monitor this indicator. In conclusion, with these strategies and frameworks, we will be able to significantly reduce medication-related harms.
