Medication Safety Beyond Institution: Issues and Magnitude of the - - PowerPoint PPT Presentation

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Medication Safety Beyond Institution: Issues and Magnitude of the - - PowerPoint PPT Presentation

Apr 04, 2023 168 likes •557 views

Medication Safety Beyond Institution: Issues and Magnitude of the Problem Pr Prof ofesso essor r Dr Dr. . Moha Mohamed med Azmi Azmi Ahma Ahmad d Has Hassali sali B.Pharm (Hons), M.Pharm (Clin Pharm), Ph.D (VCP, Monash, Aust)

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Medication Safety Beyond Institution: Issues and Magnitude of the Problem

Pr Prof

  • fesso

essor r Dr Dr. . Moha Mohamed med Azmi Azmi Ahma Ahmad d Has Hassali sali

B.Pharm (Hons), M.Pharm (Clin Pharm), Ph.D (VCP, Monash, Aust) Professor of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia. E-mail: azmihassali@usm.my

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Presentation Outline

  • Context of medication use in the society
  • Challenges in medication safety beyond institution
  • Role of pharmacists in ambulatory medication safety process
  • Recommendations for improving medication safety beyond

institutions.

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SLIDE 3

Introduction

  • Use of medicines can be complex:

– It can be used for the purpose of medical treatment or improving wellness and well being.

  • r

– Misused for other purposes.

  • Amount of medicines in market is

increasing day by day - Era of “Pharmaceutical Invasion.”

  • Over the years medicine regulation and

control have also continued to evolve, and last but not least so have people’s views and attitudes toward the use of medicine.

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Setting The New Scene ….

  • Drawn on the following resources:
  • Ministers' Summit held before the

FIP Centennial Congress in Amsterdam in 2012

  • The reports prepared for that meeting:
  • World Health Organization
  • IMS

Institute for Healthcare Informatics

  • Outline the potential savings that could be

made (both in lives and monetary terms) by addressing avoidable wastage in relation to medicines use

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Advancing The Use of Medicines

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IIHI Approach

  • Global modelling analysis of the avoidable cost opportunity based on best

available data (WHO, WB, OECD, IMS Health) from 186 different countries.

  • Focused on 6 “levers” – avoidable costs due to

 patient non-adherence  untimely medicine use  antibiotic misuse and overuse  medication errors  suboptimal generic use  mismanaged polypharmacy

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Example of Estimated Avoidable Cost from Different Countries

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About US$500 Billion May be Avoided Through Better Responsible Medicine Use

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Recommendations

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Statistics on Medicines Registered in Malaysia

2007 2008 2009 2010 2011 2012 2013 2014 Prescription 449 409 412 441 325 357 241 235 Non prescription 413 272 313 235 55 83 54 52 Natural 1342 953 1040 582 467 565 578 590 Veterinary 54 52 45 63 207 Health Supplement 168 161 85 128 200 400 600 800 1000 1200 1400

Number of products registered (2007- 2014)

2007-2014 2869 1477 6117 443 542 Cumulative Number of Products Registered Source: National Pharmaceutical Control Bureau Annual Report 2014.

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SLIDE 11

News From JAMA

Kuehn BM. JAMA. 2014 Aug 20. doi: 10.1001/jama.2014.10310.

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Findings From The National Survey On The Use Of Medicine By Malaysian Consumers 2015

Total Number of Respondents =3,081 % Did not understand the proper use of medicines 18.6% Did not recognize their own medicines generic names 46.8% Did not know the common side effects of the medicines 29.7% Did not aware on medicines expiry date 9.2% Did not know that medicines must be registered with MOH 13.8% Did not know the correct way of medicines storage 17.0% Forgot/ careless in taking medicines 73.1% Sharing medicines with others 33.9%

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The Importance of Medication Safety Beyond Hospital

  • The vast majority of health care is delivered in ambulatory settings.
  • There are 900 million visits to physicians’ offices in the United States each

year, as compared with 35 million hospital discharges, and spending on

  • utpatient care is the fastest growing segment of health care spending.
  • Adverse Drug Events (ADE) occurred in 25% of primary care patients and

that 11% of these events were preventable.

Gandhi TK, Lee TH. Patient safety beyond the hospital. N Engl J Med. 2010 ;363(11):1001-3

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Medication Safety Beyond Hospital: The Missing Link

Public/Private Hospitals Patients Discharged From These Hospitals

Option 1: visit Public Primary Healthcare For Follow up Option 2: Visit Private GPs For Follow up Option 3: Visit Community Pharmacies For Follow up

Medication Information Link Is Missing Among Institutes

Can Opt For Option 1 & 2, 2 & 3 or 1 & 3 Simultaneously

Wachter RM . Is ambulatory patient safety just like hospital safety, only without the "stat"? Ann Intern Med. 2006;145(7):547-9.

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A Case of Medication Mix-up at Patient Home

  • 76 yrs old Male patient with DM and HPT was discharged from a public

hospital after 3 days of admission due to uncontrolled DM. Patient went back to his house- staying with his wife and been given the following medications during discharge:

  • Insulin Injections
  • Frusemide 40mg OM
  • Simvastatin 20mg ON
  • Gliclazide 80mg BD
  • Following 3 weeks after discharge, the patient suffered from URTI and seek

treatment at a private hospital. The patient was given the following medications:

  • Ramipril 2.5mg OM
  • Moxifloxacin 400mg daily for 5 days
  • Bromhexine 8mg TDS
  • Simvastatin 20mg ON
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A Case of Medication Mix-up at Patient Home

  • During the home visit, there are also other medications and

supplements that the patient bought from pharmacy.

  • The patient also admits that he is confused about his medications.
  • Issues noticed during counselling:
  • The patient is taking a double dose of statin.
  • Patient is complaining of severe syncope like symptoms after taking

the first dose of Ramipril and discontinued treatment.

  • Insulin preparation was stored in the freezer.
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Medication Safety Beyond Hospital: The Challenge

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Medication Safety At Home: The Issues- Storage

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Inappropriate Use Of Medication At Home : The Issues - Safety & Cost

“Home visit by hospital pharmacists identified the

total cost of collected excessive medications from 103 patients’ house was RM 4,869.91(USD1623) with average cost RM 47.28 (USD15.76) per patient”.

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Medication Safety: Role of Pharmacists

  • Ensuring medication safety is a challenge for each dose to be administered
  • r to be taken.
  • To ascertain the safety of medications, pharmacists should be able to:
  • Ensure suitable selection and procurement of medicines
  • Warrant rational prescribing of medicines
  • Assure safer writing of prescriptions
  • Guarantee appropriate dispensing of medicines
  • Advise and manage proper storage of medicines
  • Monitor secure administration of medicines
  • Reconcile medicine histories
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SLIDE 21
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SLIDE 22
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Recommendations for Reducing The Risks of Medication Errors

Pharmacists

  • btain

better medication histories than physicians and reduce the rate and severity of medication errors during acute admissions. Furthermore, pharmacists attending medical or surgical post-take (admission) ward rounds improve drug history documentation, reduce prescribing costs, and prevent adverse drug reactions .

Agrawal A et al. Medication errors: problems and recommendations from a consensus meeting. Br J Clin Pharmacol. 2009;67(6):592-8

Taking an accurate medication history

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Dispensing of Medicines

  • Pharmacists should ensure that medicines are delivered to

patients in a safe and secure manner.

  • During the dispensing process:
  • reconcile prescription(s) and confirm indication(s) of

medicine therapy with the patient or agent

  • perform counseling and document refusal
  • ask questions to assess patient and caregiver level of

understanding

  • encourage patients and caregivers to ask questions or raise

concerns about their medicines.

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Labeling Regulation For Dispensed Medication

  • In Malaysia, since 1st January 2004, a legal requirement to include details in

the label, was made in the Poisons Regulations under the Malaysian Poison Law 1952.

  • Under Regulation 12(1) of the Poison Regulation 1952, where any poison is

sold or supplied as a dispensed medicine, or as an ingredient in a dispensed medicine, the container of such medicine shall be labelled with: – the name and address of the supplier or seller – the name of the patient or purchaser – the name of the medicine – adequate directions for the use of such medicine – the date of delivery of such medicine – where such medicine is sold or supplied and entered in a prescription book, with a reference to the serial number of the entry in such book relating to such sale or supply

  • Under the Poisons Act 1952 the penalty for the offence is fine not more than

RM5,000 or imprisonment not more than two years or both.

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Pilot Study To Assess the Appropriateness of Labeling For Dispensed Medicines

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Compliance To Standard Labeling Requirements

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Email Content from a friend received on 25th February 2016 !!!

  • Salam Dr,

Dapat ubat ini beli kat farmasi XXXXX petang tadi sebab bad

  • flu. Dua malam demam sikit, flu teruk hidung tersumbat.Boleh

makan ke?

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Medication Counseling At Community Pharmacies In Malaysia: Are We Doing Enough?

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Reconciliation of Medicine Histories

  • Medicine reconciliation is the process of comparing a patient's

medicine orders to all of the medicines that the patient has been taking.

  • This reconciliation is done to avoid medication errors such as
  • missions, duplications, dosing errors, or drug interactions at

every transition of care.

  • Pharmacists should request that the patient bring the full

names, addresses, and phone numbers of all other physicians

  • r other providers that he is seeing as well as pharmacy being

used prior to commencing treatment.

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Medication Reconciliation- Perspectives From Private Medical Practitioners

  • GPs’ Responses towards Medication

Reconciliation Program

  • Having an accurate up-to-date list of

the patient’s previous medication will be useful in the rational prescribing process (97.7%)

  • Medication reconciliation can be a

feasible strategy to improve medication safety (90.1%)

  • Medication reconciliation process

also needs to be expanded to the community pharmacy setting. (74.5%)

  • GPs’ Opinion on who should provide

medication reconciliation card:

  • Hospitals (64%)
  • MOH Health Clinics (55.8%)
  • Community Pharmacist (25.6%)
  • Clinic (39.5%)
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Medication Safety Initiatives in Malaysia

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Healthcare is Going Home !!!

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A Good Reading

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Recommendation For Pharmacists To Improve Patient Medication Safety

Bates DW. Preventing medication errors: a summary. Am J Health Syst Pharm. 2007 15;64-67

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Take Home Messages For Improving Patient Medication Safety Beyond Hospital

  • In the transition of care process, active participation by

pharmacists working in both institution and primary care in monitoring patient’s medicines management is necessary – pharmacist always need to take up their role as a ‘care coordinator’ in the society.

  • Medication safety culture education and training need to be

included in the competency training of both current pharmacy practitioners and future practitioners.

  • Pharmacist should lead the medication safety initiatives at all

levels via ‘3C’ approach- coordination, communication and commitment.

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SLIDE 37

Thank You

Mohamed Azmi Ahmad Hassali

B.Pharm (Hons), M.Pharm (Clin Pharm) (USM), PhD (Monash, Aust) School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia Tel:+604-6534085 Fax:+604-6570017 Email: azmihassali@usm.my

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Thank You

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