For World Patient Safety Day 2022, JAG project Coordinator, Anthony Olsson, sat down with Pharmacist, Roshni Patel, to discuss this year's theme, 'Medication without harm'      

World patient safety day is upon us with the theme of medication without harm. Is this an area you would like to see highlighted more?  

Yes, any medication can cause harm. There isn’t an entirely safe medication and there is potential for overdose and risk of giving it via the wrong route. Medication harm is a big focus within the NHS and there is a focus on ‘never events’. We should have the mechanisms in place to prevent incidents from happening such as safety netting.

This means looking at where things can go wrong and what stage of the process of prescribing, ordering, dispensing, administering, and disposing of medication can something go wrong. The way we do this is by collecting data and information on incidents that have happened and why they have happened. This is done in all trusts; they will all have medication safety officers who look at this and pharmacy is quite heavily involved in helping to come up with solutions in how to prevent incidents happening again.

Unsafe medication practices and medication errors are a leading cause of avoidable harm in health care across the world, what can be done to help prevent these errors?  

On a day-to-day basis on the wards in a hospital setting you would have a certain range of medication that would be allowed to be stored on the ward for nurses to be able to access easily. Other high-risk medication would have to be ordered by the pharmacist which would involve looking at the patient’s prescription, checking the dose and that the way it is being given is correct, and whether the nurses on the ward can administer this. There are some medications that require a certain level of skill to administer or need specific monitoring. If there are nurses who aren’t trained to do this, then that patient would need to be moved to a ward where it can be administered. This should be an alarm bell to say, ‘maybe we should not be providing it in this setting, and it may need a higher dependency setting’.

You haven’t got just one person there, you have a whole ward full of patients there, how difficult is it to keep track of?  It is difficult and that’s why we have a big department that cover wards. Where possible, we try to have at least one pharmacist per ward. We aim to make sure that no area is left unsafe, and we have highly skilled pharmacy technicians with new and extended roles that help the pharmacists to ensure that we can always maintain a safe pharmacy service.

During covid we had a lot of sickness throughout the NHS and the service had to be stripped back. At that time, we didn’t have patients coming in for their regular surgeries a lot of it was Covid-19. We were dealing with very protocolised treatments so when you did have the odd complex patient that’s where you would have the more senior input. This is why there are different grades of pharmacists. Their clinical knowledge is built up over time and the sharing of incidents helps everyone to learn.

Have you seen an improvement over the years with pharmacists having more prominence in supporting patients care? I have been working as a pharmacist within the St Mark’s team for over 7 years now. Our team is one of the 2 leading centres in the UK for intestinal rehabilitation and nutrition as well as being a national centre for Inflammatory Bowel Disease (IBD). I can say that pharmacists have more prominence in supporting patients care now. We have specialist pharmacists that support consultants on ward rounds with prescribing decisions. We are looked to for advice and guidance and are regularly called upon to support the wider team in getting patients home smoothly on their new medications. Our patients are complex and can’t easily be managed within the community; they are continually managed by secondary care in an outpatient setting. We liaise with community pharmacists and GP’s to educate them on the conditions that these patients have where possible and why they must have certain medications.

We have patients from all over the country and from around the world. To try and educate every GP in every area of the country is difficult. We have a national pharmacy congress every year where our team do a presentation about our specialty which involves, intestinal rehabilitation, IBD and Gastroenterology. We try to get that information out there to as many pharmacists as possible so that they understand and if they see patients with those issues, they know what to do with them and know how to access the right information.

The WHO goal within the next 5 years is to globally reduce 50% of severe medication related harm, how do you think that could be achieved?  I would like to think it is achievable and more because in an ideal world there shouldn’t be any medication errors, but the only way we stop those errors from happening is by using our incident reporting system, Datix. If there is an error within the hospital it is uploaded to the system, it is then reviewed by a medicine safety team, and they will see if there are any trends and what type of error it was. Most errors are near misses, so they almost happened, or they have happened and not caused harm to the patient because it was caught in time. The frequency of errors is what is reviewed and do we need to change our processes on the back of that information.

Employing medicine safety leads is key to making sure we have someone to oversee all of this and that it isn’t a part role that someone must do. Also, education and training of these specialist areas where they find there is difficulty in continuity of treatment, looking at why that is happening, it’s not because people are being difficult, it’s trying to be more open minded and trying to get our message out in a better way.

Technology can also help us; we have recently brought in Omnicell’s. Before we would have medication stocked on the shelves and they would be picked according to what was on the drug chart. By doing that could potentially pick the wrong medication. A lot of boxes start to look very similar and sometimes names of medications are quite similar. We often have emails sent to us about lookalike and soundalike medications so that we are aware. The Omnicell allows you to scan the patient’s drug chart and type in what you want, and it will tell you where that drug is stored. it reduces your error of picking the wrong medication. You still need to do your physical check but knowing that you have already potentially picked that correct medication helps a lot.

A future game-changer will be the introduction of our electronic prescribing (EPMA) system next year. This will help improve medication safety and provide a fully auditable trail of what has been given to our patients. It will highlight any potential drug interactions and patient allergies and reduce the potential for human error.