Medication Safety at the International Forum on Quality and Safety in Healthcare, Copenhagen 2023
A number of presentations and an e-poster on the topic of medication safety were presented at the IF on Q&S at Copenhagen 2023. This blog will discuss the relevancy to the Medication Safe and Fast initiative and the GenPRES application.
E-Poster: Improving Medication Safety and Efficiency through Clinical Decision Support Software
First of all an e-poster was presented discussing the Medication Safe and Fast project and the GenPRES application.
The poster and presentation focus on the practical utilization of the application, which necessitates merely a “functional thumb” to generate prescriptions that are both safe and fast. The QR code provides a direct link to the application, and it can be configured to various languages. To generate a prescription that includes preparation and administration, only three selections need to be made:
- The indication
- The medication
- The route of administration
Each selection subsequently narrows down the following choices to only those that are relevant. Importantly, the order of these choices does not matter. For instance, if you select a rectal route of administration, only medications suitable for rectal administration will be shown. This also applies to patient characteristics – a neonate will have a different list of possible medications compared to a 10-year-old or adult patient.
A person-centered approach to safe and effective medicines use
The congress also hosted an entire session on safe and effective use of medication. This session consisted of two presentations, both containing closely related topics to the GenPRES project.
Presentation 1. Medicines Optimisation – A change package to support Medicine Without Harm
The Medicines Optimisation Innovation Centre (MOIC) is focused on enhancing the needs of the Northern Ireland population. The center aims to accelerate the adoption of innovation into practice to improve patient outcomes and experiences and foster a culture of partnership and collaboration.
One of the key challenges identified by MOIC is medicines safety. Unsafe medication practices and errors can lead to avoidable harm in healthcare systems, costing an estimated $42 billion globally each year.
Another significant issue is antimicrobial resistance (AMR). In 2019, approximately 4.95 million deaths were reported due to AMR globally. The AMR death rate is projected to rise to 10 million per year by 2050.
To combat these challenges, the MOIC recommends various practices such as verifying penicillin allergies, reviewing antibiotic therapy, and using the shortest antibiotic duration. The MOIC also emphasizes the role of pharmacists, as highly effective hospital antimicrobial stewardship programs often have pharmacists as co-leaders.
The MOIC team has shown that optimized medication practices can reduce hospital readmission rates, improve patient quality of life, and lead to positive health economic benefits. For instance, post-discharge follow-ups led to a 15.2% reduction in 90-day readmission rates and a 9.9% reduction in 30-day readmission rates.
A significant part of MOIC’s work is around reducing medicine waste. Up to 90% of orally administered pharmaceuticals are excreted into wastewater as active substances in the feces and urine of patients.
Furthermore, MOIC highlights the importance of involving patients in decision-making, with patients reporting high satisfaction levels when their opinions are considered. The organization’s approach is evidence-based, examining the methods and factors that best facilitate quality improvement.
The MOIC uses several tools and measures to achieve its goals, such as the 7 STEPS Acronyms standardised medicine review tool, Patient-Reported Outcome Measures (PROMs), Eadon intervention scale, and Medication Appropriateness Index (MAI).
The organization invites interested parties to take up the challenge of implementing the changes it advocates for the betterment of healthcare systems and patient care.
Presentation 2. Creating a context for improvement: learning from a national medicines safety initiative
The presentation on the National Patient Safety Improvement Programmes, specifically focused on the Medicines Safety Improvement Programme (MedSIP) and its efforts to address unsafe oral methotrexate prescribing. The presentation was divided into several sections, with different speakers providing information.
The MedSIP program aims to improve medicines safety by addressing specific priority areas. Methotrexate prescribing was highlighted as a major concern, with associated adverse reactions and deaths. Strategies to reduce accidental overdose are being implemented, including changes in prescribing practices and creating awareness among healthcare professionals.
The presentation discussed the approach taken to address the issue of methotrexate prescribing. It involves identifying and engaging high-prescribing Integrated Care Systems (ICSs), understanding the local problem, taking action, ensuring quality control, and promoting networking and learning among ICSs. The intervention has shown promising results, with a reduction in prescribing observed in the targeted ICSs.
The presentation also emphasized the importance of context in improvement initiatives, citing relevant literature and the need to consider external and internal factors that influence change. The involvement of key stakeholders, a supportive organizational culture, and clear goals were identified as critical elements for successful improvement.
The presentation concluded by discussing the application of lessons learned from the methotrexate work to the Opioid Safety Improvement Programme. The importance of a whole-system approach and leveraging networks for effective change was highlighted. It also mentioned the lack of national drivers as a barrier and the efforts to establish policy drivers and financial incentives for primary care.
Overall, the presentation highlighted the efforts of the MedSIP program in addressing unsafe methotrexate prescribing and provided insights into the context and strategies for improvement.
The Medication process and Patient Safety
The medication process involves various stages, and each stage can benefit from different modes of Clinical Decision Support Software (CDSS) to improve patient safety and enhance efficiency:
- Rule-based CDSS: This type of CDSS implements pre-defined rules to ensure the generation of “Safe and Fast” prescriptions, preparation, and administration orders.
- Machine Learning-based CDSS: This CDSS utilizes machine learning algorithms to assist in treatment decisions and detect anomalies.
The GenPRES project and application focus on the initial stages of the medication process, providing support for safe prescribing, preparation and administration. For example a gentamicin order:
In the above example it is demonstrated that for each choice subsequent scenario’s are generated that the prescriber can choose from (data set and therefore the example data is in Dutch!). Each scenario is in principle valid and is derived from the available products, dose and solution rules. The result is a complete order describing the prescription, preparation and administration.
Moreover, the GenPRES system has the potential to address medication-related challenges discussed in previous presentations.
Prevention of methotrexate dosing errors
This system could contribute to solving the methotrexate problem as per design a medication prescription is coupled to the indication. For instance, it can contribute to the prevention of methotrexate dosing errors by configuring the system to only offer 10 mg products for oncology indications and 2.5 mg tablets for non-oncology use.
Optimization of medication
Additionally, the integration of the indication (purpose) of the medication order into the prescription process enables machine learning to provide a reliable medication review. This approach supports the goal of “medicine without harm” discussed in the initial presentation. The key to success lies in adopting an integrated approach that encompasses all stages of the medication process.
Conclusions
Medication safety is a persistent concern in healthcare. However, by incorporating smart Clinical Decision Software combined with Machine Learning and AI, there is significant potential to greatly reduce medication errors. Achieving this goal requires a comprehensive approach that encompasses all stages of the medication process. While addressing the challenges of medication safety can be complex and resource-intensive, implementing effective solutions can have a substantial positive impact.
Questions?
mail me at: c.w.bollen@umcutrecht.nl
