Australian Medication Safety Services PTY LTD

Expert Advice on Medication Matters
 
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Principal Consultant

Dr Chris Alderman B Pharm PhD FHSP BCPP BPCG Dip Proj Man

Australian Medication Safety Services

Expert Advice on Medication Matters

GROUP VALUES
Australian Medication Safety Services is an agile, responsive consulting service that is available to provide advice and assistance in achieving best quality outcomes from medication usage.  With experience across a range of settings around around Australia and around the world, the services offered range across a variety of sectors – all of which can assist in rendering medication usage less risky and more likely to achieve effective and efficient outcomes.
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The safety and  wellbeing of patients are our foremost priority. Any action or recommendation that could compromise consumer protection will never be considered as an option

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The safety and wellbeing of practitioners/staff involved in medication use are also paramount considerations, the organisation will never create a serious adverse impact on the safety, health or wellbeing of these other stakeholders

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Providing good value for money is important – clients should feel satisfied that they have received good work for a fair price, delivered on time

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The organisation is guided by the key principles of acting ethically, honestly and with integrity, basing all recommendations and actions on these values;

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Our group is committed to fairness, equality and environmental awareness
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Information about safe and effective use of medications evolves rapidly – we maintain timely access to high quality and authoritative sources in medical, nursing and pharmacy literature and frequently update resources and position statements that are made availabel to clients using the group’s services

Effective medications are  one of the most important advances in the history of medicine, leading to significant increases in life expectancy in recent decades.  Medicinal drugs (also called medicines, or medications) are used for the management of disease processes, alleviation of symptoms, prevention of disease progression, and in some cases to protect against the development of illnesses or symptoms. All medications have the potential to create benefit and also to do harm – safe and judicious use of drugs is important for individuals and on a societal scale.

News and resources section

Assessment of medication safety

The use of medications is very widespread in Australia and around the world.  The Australian government spends billions of dollars on medications for subsidised supply to the public, both in the community (through the Pharmaceutical Benefits Scheme – PBS pbs.gov.au) and also in hospitals and clinics.  Medicines undergo stringent evaluation to assess their effectiveness in producing the benefits that are claimed to be associated with their use. At the same time, they must also undergo assessment of safety, so that the pattern of adverse effects (side effects) and drug interactions can be characterized. This safety information is derived in large part from clinical trials, and although this data can be useful as a broad and general guide, there are many factors to consider in interpretation.

A range of factors influence the way we interpret medication safety data:

Clinical trials

One of the best sources of information about the safety and efficacy of drugs is derived from clinical trials. Although a valuable source of information, trials also have a number of limitations that are not always well-understood. For example, almost all trials are funded by the sponsor companies that have a commercial interest in focusing attention on the positive aspects of the findings of the research.

By necessity, the trials focus exclusively on the efficacy & safety of the drug when used for a specific clinical indication, and do not necessarily address other areas of potential clinical use – this means that as years go by, some medications start to be widely used for non-approved indications that are not directly related to the parameters of the original research.  Clinical trials tend to focus upon a relatively small cohort to people that are not necessarily representative of wider society – true patterns of adverse effects or drug interactions are often not apparent in the context of a clinical trial, no matter how large – the world’s community of clinicians relies upon post-marketing surveillance to uncover these effects, where patterns emerge after the use of medications of a period of years.

Medical Factors

Factors such as concomitant medical illnesses, concurrent drug therapy, ethnicity, genetics and a range of other potentially influential factors are not necessarily the same in a clinical trial cohort, when compared to the population in which the medications are actually intended to be used. Typically, very young children and older people are prone to be sensitiive to the effects of medication, and careful attention is needed when using medicines for patients from these sub-groups of the population. 

It is well known that the likelihood of adverse drug reactions and serious drug interactions increases in a non-linear fashion, so as the number of medications used increases, the risk of medication-related problems rises dramatically. The these reasons it is important to work towards deprescribing (www.nps.org.au/australian-prescriber/articles/deprescribing) and make efforts to avoid polypharmacy (www.nps.org.au/australian-prescriber/articles/the-dilemma-of-polypharmacy)

There are many other specific factors that impact upon medication safety for an individual patient – these can be assessed with a systemic medication review.

Institutional Factors

To facilitate safe use of medicines in hospitals, aged care facilities, prisons and other institutional settings, it is critical that a range of organisational factors must receive appropriate attention.  Facilities must maintain attention to tasks such as formulating, documenting and maintaining medication-related policy and procedure; the safe operation of drug distribution processes (addressing the movement and storage of drugs), and the provision of appropriate training for all staff involved in each step of the medication usage process.

In addition to ensuring the safe distribution of medications it is also vital appropriate oversight of medication use must be maintained. Many of the functions required for this are provided through the delivery of clinical pharmacy servcies (www.shpa.org.au/resources/standards-of-practice-for-clinical-pharmacy-services) . These services are a vital component for ensuring safe and effective medication use. In addition, the operation of multidisciplinary governance committess is also vital – for example Drug & Therapeutics Advisory Committees (DTACs) and Medication Advisory Committees (MACs) in hospitals and Aged Care respectively.

All medicines have the potential to do harm

 
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Reducing potential for medication-related problems

 
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Australian Medication Safety Services

 
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Safe and effective medication requires careful and systemic attention

All medicines have the potential to do harm

Some of the side effects associated with medications are relatively predictable, and information about these problems should be considered when making decisions about which medicines to use for an individual. At times, however, the adverse impacts associated with medications are not necessarily predictable based on simple factors or previous experience. Given that medications are very widely used, have the potential to do great good as well as significant harm, and are associated with significant expense it is important that steps are taken to maximise the likelihood a benefit and minimise the risks associated with these products. Many factors need to be taken into account when considering the issues that influence drug safety. In an individual sense these include modifiable factors that need to be considered when formulating a treatment plan for individual. These are based on these so-called “medication-related problems” (refer www.ncbi.nlm.nih.gov/pubmed/2275235) Factors that need to be considered by doctors pharmacists, and other people such as nurses who are involved in providing safe and effective care for patient are broadly based on the principles of Quality Use of Medicines (refer below)

 www.Health.Gov.Au/internet/main/publishing.Nsf/Content/8ECD6705203E01BFCA257BF0001F5172/$File/natstrateng.Pdf

Factors to consider considering in reducing potential for medication-related problems

Medication-related problems can arise from many different issues:

  • Is there a requirement for a medication that is not yet prescribed but might be helpful?
  • Is this person prescribed medication that is not necessarily definitively needed?
  • If medication has been prescribed, is the dosage appropriate?  Would a smaller dose achieve a similar effect without exposing the patient to risks of adverse effects?  Is the dose that is being used adequate to achieve the desired result? Is the route of administration appropriate/optimal, and is the duration of treatment well-matched to requirements?
  • Are side effects currently present, or is there a risk they might develop in the future?  Have problems occurred in the past (an allergy or hypersensitivity)? If there are side effects can these be managed to reduce the impact upon the patient?  What is the impact of the side effects relative to the benefit expected?
  • Does the treatment need to be adjusted to accommodate factors such as impaired kidney function, liver function, for genetic variability in drug metabolism? Refer https://www.Medscape.Com/viewarticle/444804_1
  • Are there important interactions between the drugs taken by the person?
  • Is the medication being taken as prescribed? Are there problems with availability or affordability?
A discussion of medication safety needs to be broader than the context referred to above. Especially in institutional settings there are many factors that influence the safe prescribing dispensing tradition and administration of medications.  In settings like hospitals and nursing homes it is important that steps are taken to monitor the safety of the processes that govern medication use, and that appropriate processes are put in place to achieve continuous improvements.  This could include factors such as error reporting, and process modification with a view to decreasing the likelihood of inadvertent harm.
To understand how to maximise the safe and effective use of medicines it is necessary to consider the various elements of the Medication Management Pathway. Conceived by the Society of Hospital Pharmacists of Australia, the cycle places the consumer at the centre of efforts to make medication usage more efficacious and less harmful. The pathway involves the input of various professionals in different activities, including prescribing, medication order review, dispensing/distribution and storage of medicines, the administration of treatment and monitoring for effects. As well as doctors, nurses, pharmacists and other health professionals, the consumers themselves have key roles to play. Image copyright SHPA

Contact Australian Medication Safety Services

PO Box 179, Glen Osmond, South Australia

 

Email admin@medsafetyaustralia.com.au