Medicines management — patient safety

< Influencers contents | Print this page

The National Patient Safety Agency

The National Patient Safety Agency (NPSA) has a growing interest in the safety of medicines and a forward work programme is provided for it by the DH. Building a safer NHS for patients: improving medication safety looks at everything from medication errors; safe prescribing/dispensing/administration of medicines; how to reduce risks in patient/medicine groups as well as improved labelling. The paper follows on from the chief medical officer’s report in 2000, An organisation with a memory. The new report picks up on repeat prescribing and electronic prescribing and there is also some content on the safer use of medicines in children because ‘many medicines prescribed for children are only available as adult dose forms’ and comment that the range of opiate analgesics used in primary and secondary care should be limited.

There are possibly big implications for companies around this document. It does suggest the need for the MHRA to work much closer with manufacturers but there are other issues going on here too. In the last year or so there has been a renewed focus on drug safety post-license with thoughts appearing within the NHS along the same lines as the difference between efficacy (demonstrated in clinical trials) and ‘real word’ effectiveness. In other words, drug safety is not really ‘sorted’ by the time of registration! So is another kind of fourth hurdle being created here as yet another excuse for not using new drugs? Will this report exaggerate this whole area? Although the focus of the report is mostly on the 200m prescriptions in hospitals there is a recommendation that ‘overarching’ national standards should be developed linking the various strands of medicines use within the NHS and that the NPSA, together with NICE, should take this forward. There is also some comment about education and training for medication safety and there may be some real opportunities here for companies.

The safety of medicines featured in a BMJ theme issue on the benefits and harms of medicines. There was good news and bad news… Too many people are dying in hospitals unnecessarily because of drug side effects (common drugs like aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), in combination with contraindicated drugs) and thus ‘bad’ prescribing is going on. Adverse drug reactions cost the NHS some £466m every year and account for one in 16 hospital admissions. One major study, involving almost 19,000 patients admitted to two NHS hospitals over a six-month period, showed that 1,225 cases (or 6.5 per cent) related to an adverse drug reaction. In addition, 28 (2.3 per cent) of these patients died as a result of their reaction, most of which were defined as ‘definitely’ or ‘possibly’ avoidable. The authors called for new measures to be put in place to lessen the burden of adverse events on the NHS and to improve the risk/benefit ratio of the drugs. This, they say, could be helped to a great extent by improvements in prescribing. But this links nicely to pharmacogenetics as any drug response depends on genes, the environment and behaviour. For more information see ‘Adverse drug reactions as cause of admission to hospital: prospective analysis of 18,820 patients’.