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Safer Medication & Medical Devices
Medication Safety & Hospital Admissions Avoidance
30th June 2015
Dr Ahmed AmeerMedication Safety Officer
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Outline for Session
• How big is the issue?• Is the situation getting better or worse?• Medication Review taken seriously enough?• What should we all be doing about it?
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Important academic references
• 11.2% patients had adverse drug events (ADEs) causing hospital admission (47.6% preventable)
• Patient age , time since starting new medicine and total number of medicines independently predictors of admission
• Antiplatelets, anticoagulants , diuretics, ACE inhibitors and anti – epileptics major culprits
Kongkaew, C., Hann, M., Mandal, J., Williams, SD, Metcalfe, D., Noyce, P. & Ashcroft, D. Risk Factors for
Hospital Admissions Associated with Adverse Drug Events. Pharmacotherapy 2013; 33: 827-837
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Important academic references
• 6.5% UK hospital patients admitted due to Adverse Drug Reactions (ADRs)
(72% preventable) Pirmohamed et al BMJ 2004;329:15-19
• Preventable drug related problems accounted for 3.7% of hospital admissions. Antiplatelets, Diuretics, NSAID’s accounted for 50% of all admissions Howard et al BJCP 2007;63:136-4
• 20.8% patients readmitted to hospital due to ADR within 1 year of first admission.
Diuretics & Antiplatelets most frequent
culprits Davies EC et al BJCP 2010;70:749-55
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BUT under recognised because under reported ?
• International Classification of Disease (ICD) coding from hospital databases are not reliable for identifying ADRs Hohl CM,Karpov A, Reddekopp Let al. ICD-10 codes used to identify
adverse drug events in administrative data: a systematic review J Am Med Inform Assoc 2014;21:547–557
• Only 9% of adult patients admitted to a UK hospital with a confirmed medication related harm (ADRs , medication errors, non-adherence) had a related ICD
code documented. Reynolds M et al. A descriptive exploratory study of how
admissions caused by medication-related harm are documented within inpatients’ medical records. BMC Health Service Research 2014; 14: 257
• Hohl CM,Karpov A, Reddekopp Let al. ICD-10 codes used to identify adverse drug events in
administrative data: a systematic review J Am Med Inform Assoc 2014;21:547–557
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BUT under recognised because under reported ? (2)
• 31.5% of children admitted to a UK hospital with a confirmed ADR had a related ICD code documented Bellis et al. BMC Pharmacology and Toxicology 2014, 15:72. Clinical coding of prospectively identified paediatric adverse drug reactions – a retrospective review of patient records
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And the situation is only getting (and will get even) worse
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Polypharmacy meets Multi-morbidity
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Medication Reviews
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And there are plenty of tools to help
• NICE Medicines Optimisation guidance • Kings Fund , Scottish and Welsh Polypharmacy
documents (CPPE focus too 2016)• Seven steps to managing polypharmacy: Specialist
pharmacy Services document• Reducing Inappropriate Polypharmacy: The Process
of Deprescribing Scott IA et al JAMA Intern Med 2015.
doi:10.1001/jamainternmed.2015.0324
• STOPP START Gallagher P et al Int J Clin Pharmacol Thera 2008;46:72-83
• No Tears Using the NO TEARS tool for medication review. T Lewis. BMJ 2004;329:434
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Medication Review taken seriously enough?
Can we compare it with a routine Total Knee Replacement (TKR) ?
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Total Knee Replacement
• Preoperatively (50 mins)
• Preop assessment clinic (30 minutes Nurse + 20 minutes Doctor)
• Tests: ECG, bloods, and MRSA swabs
• Consent form
• Day of Surgery (150mins)• Anaesthetic pre-op
assessment (10 min) • Anaesthesia-spinal or GA
(20 min) Anaesthetist plus ODP or nurse
• Surgery (90mins) 2 scrub nurses, 2 surgeons,1 anaesthetist, 1 runner
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Total Knee Replacement (2)
• Post operatively• Recovery (60 mins)
1 Anaesthetic nurse• 3-4 days on ward,
OT and PT twice a day
• Post discharge • Continue physiotherapy for
several weeks individually in a group depending on the patients needs
• Follow up clinic appt with doctor
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A typical Medication Review?
• 1 GP/Pharmacist (10 mins)
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So what could the NHS be doing about it ?
www.england.nhs.ukThomas J. A multidisciplinary approach to reducing avoidable medication-related harm/hospital admissions. Clinical Leadership Conference 2013. www.learningwales.tv/group_items/view/1354
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2020: NHSE Medicines Optimisation Dashboard to include Medication related admissions per CCG ?
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2020: Patient Reported Outcome Measures (PROMs )for Medication Review ?
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But finally what could YOU be doing about it ?
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Is balancing the Prescription Equation your key to medication related admissions avoidance?
“If we just keep adding, and not subtracting, we just multiply the medication problems”
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NPC guide to medication review 2008
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Important References
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