Innovation to reduce medication‐related harm

Abstract

There have been significant efforts to prioritise activities that reduce medication-related harm since the publication of Australia’s response to the Global Patient Safety Challenge. In an earlier editorial in the Journal, Steven Waller recognised these efforts, outlining the significant work being done in medication safety and identifying a number of specific areas needing further improvement. He specifically recognised the continuing education of health professionals, communication relating to transitions of care, and the potential expansion of stewardship programs in hospitals as priorities in reducing harm from high-risk medicines. It is encouraging that in this issue we have a number of papers focusing on these three priorities. In the first of these, McCleery et al. undertook an evaluation of an education program for intern medical officers (IMOs) commencing rotations at a large tertiary hospital where prescribing was undertaken using a digital system. This work is very informative as digital prescribing is becoming commonplace; over one-third of Australian public hospitals now have an inpatient electronic medication record. A pharmacist-led education intervention was delivered to IMOs at orientation and consisted of an introductory lecture and four interactive tutorials. These included hands-on experience to prescribe safely within the electronic medication management (EMM) system, the integrated electronic Medical Record. Preand postprogram questionnaires explored IMO confidence with prescribing across key areas, and results from 56 IMOs were included in the analysis. There was an improvement in self-confidence in all scenarios examined, with the authors concluding appropriately that the program resulted in improved prescribing skills. Programs such as this should be routinely delivered, and the authors should be congratulated on developing and evaluating this program. What is concerning, and identified in the paper, is the reported limited preparedness of IMOs to undertake the activities of daily prescribing after completing their medical degree. The reported self-confidence in the prescribing of warfarin, assessing venous thromboembolism risk and the prescribing of insulin – even after the education program, albeit improved statistically – still showed much room for improvement. No doubt practice will improve these skills, with the support of the experienced doctors and pharmacists who work alongside IMOs. Yet while this study clearly shows the benefits of this targeted intervention, it also demonstrates how much more must be done to reduce the potential for medication-related harm and the need to prioritise the continuing education of health professionals. The second priority identified by Waller – communication and information sharing at transitions of care – is addressed in another paper in this issue, focusing, in this case, on the setting of hospital outpatient clinics. In the study by Snoswell et al., an evaluation was undertaken of the activities of pharmacists in a range of ambulatory clinics after the implementation of a major investment in clinical pharmacy services. As expected, the primary role was the taking of medication histories and documentation of adverse drug reactions, along with the documentation of recommendations for dose adjustments and the withholding of medications prior to surgery. Unfortunately, there was no detail regarding the impact of these roles on patient care directly, but hopefully this will not be far away. The authors rightfully acknowledge the preliminary nature of this scoping study; more importantly, however, this study challenges others to be as innovative and seek funding and resources for implementation of these roles in ambulatory clinics. The third paper, by Bui et al. – and one in which I have a conflict of interest in highlighting – outlines the early experience of two innovative stewardship programs that focus on anticoagulation and analgesic use that have been in place since 2016. This paper describes the core elements of established stewardship programs, namely an antimicrobial stewardship program and its application to the development and introduction of analgesic and anticoagulation stewardship programs, with the key learnings associated with the two new programs being outlined. The challenge is the implementation of these programs more broadly, and there is a growing interest in national adoption. In 2018, the Society of Hospital Pharmacists of Australia recommended the adoption of stewardship programs in public and private hospitals nationally to prevent and mitigate opioidrelated harm. More recently, in April 2021 the Australian Commission on Safety and Quality in Health Care (ACQSHC) initiated public consultation to support the development of a national opioid analgesic stewardship program. The key areas within the scope of this program are the prescribing of opioid analgesics in the