Walsall Healthcare NHS Trust Medicines Management

ADVERSE DRUG REACTIONS (ADR) British Medical Journal 2004:329:15 Pirmohamed et al 18,820 patients studied 1225 admissions related to an ADR a prevalence of 6.5% the ADR directly leading to the admission in 80% of cases. The median bed stay was eight days, accounting for 4% of the hospital bed capacity. The projected annual cost of such admissions to the NHS is £466m The overall fatality was 0.15%. Most reactions where definitely or possibly avoidable. Aspirin, NSAIDS, Diuretics, warfarin World Health Organisation Unintended, harmful reactions to medicines (known as adverse drug reactions) are among the leading causes of death in many countries. The majority of adverse drug reactions (ADR) are preventable. People in every country of the world are affected by ADRs. In some countries ADR-related costs, such as hospitalization, surgery and lost productivity, exceed the cost of the medications. No medicine is risk free. Vigilant assessment of the risks and benefits of medicines promotes patient safety.

ADVERSE DRUG REACTIONS Risk Factors Age (children and elderly) Multiple medications Multiple co-morbid conditions Inappropriate medication prescribing, use, or monitoring Organ dysfunction Altered physiology Prior history of ADRs Extent (dose) and duration of exposure Genetic predisposition

ADVERSE DRUG REACTIONS Classification MHRA Type A - Augmented Type B – (Bizarre) Idiosyncratic Type C - Continuing Type D - Delayed Type E – End of treatment Classification NPSA 0 - Near Miss 1 – No Harm (116,622) 2 – Low Harm (14,453) 3 – Moderate Harm (3327) 4 – Severe Harm (234) 5 – Death (47)

NRLS – incident report

MEDICINES SAFETY – THE ROLE OF PHARMACY Part of the team At ward level In the community Education and training Patients Other healthcare professionals Analysis of medication errors Management of controlled drugs Checking and dispensing prescriptions Leadership for medicines management National Patient Safety Agency Local solutions to medication errors Audit (CQUIN) Governance Nationally – UKMI/NELM NPSG Quality Assurance

MEDICINES SAFETY – THE ROLE OF PATIENT Understand your medications What are they for How often do I take them For how long What can I expect Making every contact count Lists of medications What you aren't taking What you cant take What support you need Green bag

MEDICINES SAFETY – THE ROLE OF PATIENT Report problems & concerns Pharmacist GP Any Adverse drug event Report problems & concerns Regulatory agencies Any new drug Type B – Unexpected Any ADR that has significantly impacted on activities of daily living Counterfeit products

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Supporting the discharge process

Thank you for listening, any questions? Good medicines management means that patients receive better, safer and more convenient care, it leads to better use of professional time and enables skilled practitioners to focus their skills where they are most needed, thus effective medicines managements benefits everyone.