USING MEDICINES SAFELY how carers can help This presentation may be of interest to carers of patients with mental illness. The presentation gives some background information about medication error, and describes how carers can help reduce errors that occur at the point of admission to hospital; so called medicines reconciliation errors.

Medicines can: help many people with physical and mental health problems to cope better with the symptoms of their illness have side effects cause problems if they are started or stopped suddenly or taken in some combinations We can all play a part in making sure that medicines are used safely Medicines are helpful across a wide range of mental health problems in people of all ages. For example children with ADHD can be helped by stimulant medicines, adults with depression by antidepressants, older people with dementia by memory enhancing drugs, and people of all ages with schizophrenia by antipsychotic medicines. Some medicines can cause bad side effects if they are started at too high a dose (for example if they are not taken for some time then started again at full dose). This is because the body has not had enough time to get used to smaller doses first. Examples include clozapine, amitriptyline and carbamazepine. Some medicines, if stopped suddenly can increase the chance of becoming unwell again very quickly. An example is lithium. Some medicines can cause problems when taken together. For example if a patient who takes lithium, also takes ibuprofen and their lithium level has not been checked, they may become lithium toxic (lithium poisoning). Herbal preparations such as St John’s Wort can greatly increase the side effects associated with SSRIs such as fluoxetine. We all need to work together to make sure that patients get the maximum benefit from their medicines and that the risk of harm is minimised.

We can all help to reduce the risk of thing going wrong. Every day, two and a half million medicines are prescribed for patients in hospitals and the community. Most medicines are prescribed and administered/taken safely but sometimes mistakes happen that can lead to harm to patients. We can all help to reduce the risk of thing going wrong. The National Patient Safety Agency is responsible for collecting information about patient harm in the NHS and advising healthcare staff on how to prevent harm from occuring. The NPSA has produced a report about harm caused by medicines. This includes near misses (where harm could have occurred but didn’t). The report aims to highlight the importance of ensuring that medicines are used as safely as possible.

Mistakes with medicines are very common Although most do not cause harm, a small number do This report gives information on the number of incidents involving medicines that could have caused harm, and that did actually cause harm. Note the large number of incidents that were reported over a period of just 18 months. These reports came from all healthcare settings, not just mental health.

The point at which a patient comes into hospital is known to be a time when mistakes involving medicines are more likely This can be because the patient does not bring their medicines with them or the doctor does not know about medicines that are being prescribed by another doctor NICE and the NPSA have joined together to try to help with this problem We all need to work together to make this happen Errors/mistakes involving medicines are known to be more common when a patient moves from one healthcare setting to another, such as when they are admitted to hospital. This has led to NICE and the NPSA working together to develop a guideline on medicines reconciliation. This guideline aims to ensure that there are no unintentional discrepancies between what a patient was prescribed in the community and what is prescribed at the point of admission to hospital. Carers can help to ensure that medicines reconciliation takes place by bringing all medicines the patient is taking/was supposed to be taking into hospital for the doctor/pharmacy staff to see. This will prevent important medicines being missed.

A service user’s perspective There is a culture of sharing medications, so people may be taking something that was prescribed, but not for them. Service users may only tell their psychiatrist what they think they want to hear; that is about medicines related to that speciality. Medication for physical health problems may not be mentioned. Oral contraceptives may be missed. Also, herbal medicines, or medicines such as ibuprofen that can be bought without a prescription may not to be mentioned. Mental health service users may be reluctant to tell a clinician that they have reduced or stopped taking their prescribed medication because they think they will be told off. This is what a service user said about their medicines. There is a culture of people talking about what has worked for them and sometimes being generous enough to allow someone else a number of tablets so they can try it for themselves. So people may be taking something that was prescribed, but not for them. When a service user is seeing a consultant for a physical problem as well as for a mental health problem, when asked about medication they may tell each consultant only what they think they want to hear, that is, the drugs to do with that specialty. This is because any medication for the other problem will be seen as not their concern (and it can seem as if the consultants see it like that too). Also when someone is taking herbal preparations, especially if they have not been obtained from a Western medical source like a pharmacy or other shop (across-the-counter), they may not be mentioned when that person is talking about psychotropic medication they are taking. Herbal preparations, for example, will tend not to be mentioned.

The Prescribing Observatory for Mental Health has looked at what happens when patients with mental illness come into hospital For 3 patients out of 10, there was not enough information available about medicines that were being taken before admission. For 2 patients out of 10, when this information was available, it led to the hospital prescription being changed In June 2009, POMH conducted an audit looking at medicines reconciliation. Forty-two Trusts submitted data for 1,790 patients from 375 clinical teams. The findings support the conclusions from the NPSA that the point of admission to hospital is a time of high risk for medication error

What sort of problems were found? Important medicines used for physical health problems had been missed heparin used to treat blood clots in the legs and lungs inhalers used to treat asthma and other breathing problems tablets used to treat diabetes Out of date doses were prescribed lithium antipsychotic medicines antidepressant medicines Patients may be too unwell to make sure the doctor knows all of the medicine that they have been taking or should be taking. These are examples of the problems identified. You may be able to think of more from your own experience.

How can patients and carers help? Bring all medicine the patient is taking or should be taking into hospital for the doctor to see. This includes: Medicines prescribed by the GP Medicines prescribed by another hospital doctor Medicines that the patient has bought without a prescription Herbal, natural or alternative remedies