Medicines heal, but they can also harm you


Polypharmacy, or the prescription of more than one medication, is one of the situations where the risk of medication harm is high. — TNS

Everyone will, at some point in their lives, take medication to prevent or treat illness.

Medications have changed the human ability to live with disease and generally increased lifespan.

However, medications do sometimes cause serious harm if taken incorrectly, are monitored insufficiently, or as the result of an error, accident or communication problem.

Patient safety experts have found that mistakes in healthcare are usually due to flawed or dysfunctional healthcare systems, processes and procedures, and rarely due to neglect.

The inevitable consequential errors also apply to medication harm.

A medication error has been defined by the US National Coordinating Council for Medication Error Reporting and Prevention as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer”.

All medication errors are potentially avoidable.

They can be greatly reduced, or even prevented, by improving the systems and practices of medication, including ordering, prescribing, dosing, preparation, dispensing, administration, timing and monitoring.

Scale of harm

Unsafe medication practices and medication errors are a leading cause of avoidable harm in healthcare systems globally.

The scale and nature of this harm differs between countries.

The annual global cost associated with medication errors has been estimated at US$42 billion (RM188.66 billion).

Patients in low-income countries experience twice as many disability-adjusted life years (DALYs) lost due to medication harm than those in high-income countries.

Medication errors occur when weak medication systems and/or human factors like fatigue, poor environmental conditions or staff shortages, affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability, and even death.

Errors occur most frequently during administration; however, there are risks at different stages of the medication process.

Whenever medication harm is mentioned, my memory goes back to an incident when I was a medical officer in a surgical unit.

I had performed a splenectomy (removal of the spleen) on a 15-year-old boy after he sustained a ruptured spleen following a road traffic accident.

On the third day after the operation, he was prescribed chloroquine for malaria, which he had contracted in the hospital.

The next day, he died from chloroquine toxicity following the administration of 10 times the prescribed dose.

Following an inquiry, the responsible staff member was transferred to the medical ward.

This year’s Challenge

World Patient Safety Day is observed by member states of the World Health Organization (WHO) on Sept 17 every year.

The theme for 2022 is “Medication without Harm”, which is the third WHO Global Patient Safety Challenge (GPSC).

The previous two GPSCs were “Clean Care is Safer Care” and “Safe Surgery Saves Lives”.

The vision of the 2022 GPSC is to reduce the level of severe, avoidable harm related to medications by half over the next five years globally.

The four objectives of the 2022 World Patient Safety Day campaign are:

  • Raise global awareness of the high burden of medication-related harm due to medication errors and unsafe practices, and advocate urgent action to improve medication safety.
  • Engage key stakeholders and partners in the efforts to prevent medication errors and reduce medication-related harm.
  • Empower patients and families to be actively involved in the safe use of medication.
  • Scale up the implementation of the WHO GPSC: Medication Without Harm.

Key messages

There are key messages in the 2022 GPSC for patients, families and the public; healthcare professionals; healthcare leaders and facility managers; and policymakers and programme managers.

> For patients, families and general public

When prescribed a medication, check with your healthcare professional that you are given all the information needed to take it safely.

Follow the “Know, Check, Ask” actions for patients/caregivers: Know your medication, check the dose and timing, and ask your healthcare provider if you have any doubts.

Keep an updated list of all the medications you take, including traditional medicines, and share it with your treating healthcare professional.

Take the medications as recommended by your healthcare professional.

Use the 5 Moments for Medication Safety tool, which are key moments when action taken can reduce the risk of medication harm.

Be aware of the potential side effects of your medications.

Store medications as indicated and check the expiration date regularly.

Raise any concerns about your medication with your healthcare professional.

> Healthcare professionals

Keep your skills in safe medication practices up to date.

Engage patients through shared decision-making with tools such as the 5 Moments for Medication Safety, and implement actions related to the Know, Check, Ask campaign, i.e. know the medication; check it is for the right patient and is the right medicine, route, dose and timing; and ask the patient if they understand.

Provide clear and full medication-related information to all members of the clinical team throughout the process of care.

Report medication safety incidents, and share and apply lessons learned with your team and patients when possible.

Be mindful of situations where risk from medications is high and ensure that safety measures are followed.

Mentor new members of your team on safe medication systems and practice.

> Healthcare leaders and facility managers

Designate a focal point and a multidisciplinary team to develop processes to ensure medication safety in the facility.

Develop and implement standard operating procedures for safe medication use, taking into account the risk of human error.

Make sure there are sufficient staff to cover patients’ medication needs.

Provide opportunities to train health professionals on safe medication use.

Operationalise a patient safety incident reporting and learning system, including medication safety incidents (medication errors and related harm).

Create a safety culture where health professionals are able to raise safety concerns related to medications.

Prioritise action in areas where most medication-related harm occurs, such as high-risk situations, transitions of care and polypharmacy.

Put in place strategies to reduce the risk of medication errors, such as double-checking, patient engagement and using information technology to improve processes.

> Policymakers and programme managers

Ensure medication safety is addressed at all levels/settings in the healthcare system.

Assess the burden of medication-related harm in your country.

Integrate medication safety into every stage of patient care.

Co-design and implement medication safety programmes with stakeholders, including patients and public.

Establish a patient safety incident reporting and learning system, including medication safety incidents (medication errors and related harm).

Monitor progress and evaluate the impact of medication safety programmes.

Launch the Know, Check, Ask campaign to promote medication safety across the country.

The WHO Strategic Framework of the GPSC depicts the four domains of the challenge, i.e. patients and the public, healthcare professionals, medicines, and systems and practices of medication.

Each domain is further described through four subdomains.

The three key action areas – namely, polypharmacy, high-risk situations and transitions of care – are relevant in each domain and thus form an inner circle (see graphic).

Everyone has a role in reducing the incidence of medication harm.

Patients and the public also have a critical role to play to ensure that they do not become the subjects of medication harm.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. For more information, email starhealth@thestar.com.my. The views express-ed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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