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Addressing the Polypharmacy Challenge in Older People

The Polypharmacy Challenge Blog

Medication errors: Latest figures show most likely in older people and those experiencing comorbidity and polypharmacy

Najia Sultan, Academic Clinical Fellow reflects on a recently published report which has caught the attention of the media.

Latest research released last week has highlighted worrying levels of medication errors made in the NHS every year. The findings have been widely reported in the popular media and were highlighted by the Secretary of State for Health Jeremy Hunt at the Global Patient Safety Summit in London last week.
Titled ‘Prevalence and Economic Burden of Medication Errors in the NHS in England’, the research was conducted by academic teams at the universities of Sheffield, York and Manchester. It used published data to estimate the number of medication errors occurring in England annually. A medication error is defined as ‘a preventable event that may lead to inappropriate medication use or patient harm’. This may include the incorrect dose or wrong medication being given for example. Patients at the receiving end of medication errors may experience harm through adverse reactions, hospital admission or at worst, death. In cases where the error is recognised there is the additional emotional burden of being at the receiving end of a medical mistake, both for patients and people involved in their care.
The study estimated that 237 million medication errors occur at some point in the medication process in England per year. Though the vast majority of these have no or little potential for harm, over a quarter were deemed potentially clinically significant (i.e. could cause moderate or severe harm). Error rates per patient in primary care were lower than hospitals and other settings. However, over 70% of the clinically significant errors occurred in primary care. This is likely related to the proportion of prescribing that occurs in this sector. Crucially, medication errors were most likely to occur in older people, or in the presence of co-morbidity and polypharmacy.
This research adds to the body of evidence that suggests that medication errors and harm associated with these are far more prevalent in the day-to-day care of patients then has historically been recognised. It is thought that the data for the UK is similar to that of the US, other EU countries and comparable settings. These findings reinforce the need for improving broadly our evidence base for managing polypharmacy in multimorbidity, especially in patients who are older adults.
Top-down data analyses of published research, such as this study, are excellent at highlighting the system-wide areas of care that need to be improved. Studies such as APOLLO-MM can contribute to offering insight into the ‘real world’ system, and the human experiences and practices of patients, carers and health professionals who are the key players in a complex system.
A key recommendation of this report is the implementation of interventions that ‘work in the real world’ to combat medication errors. Looking forward, changes such as improved electronic prescribing and better integration of computer systems between GP practices, pharmacies and hospitals may help reduce errors, but the call to implement interventions that ‘work in the real world’ does require us to have a keen grasp of this ‘real world’ context. Ethnographic research such as that we are conducting in APOLLO-MM can shed light on this ‘real world’ context. The real world includes an aging population, increasing multimorbidity, an expanding repertoire of drugs and medical technologies and an NHS which is increasingly overstretched. Vigilance to protect patient safety is extremely important and may be challenging to achieve in this environment, and it is important to understand how this is done in practice.
Two of the four fundamental principles of bio-medical ethics are non-maleficence (‘do no harm’) and beneficence (‘do good’). At their core therefore, prescribing practices should always ‘do no harm’ and should certainly aim to ‘do good’. Honest and reciprocal conversation and consultation between prescribers, dispensers and patients is likely to be one crucial element in ensuring that prescribing practices reflect these ethical commitments.

Further media coverage: BBC, The Guardian, The Independent

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