Introduction

A new blog concept for my website. These blogs tend to be small and introduce a concept or talks about an experience I had. Bite-size blogs should be a little less than 2 minutes read and may be less than 600 words. Nothing too prominent with a relaxed feel to it and no insane reference list.

In this edition of Bite-Size, I wanted to talk about medication safety and their impact on patients. Medications are as present as the disease itself, and awareness and education are essential. As medical students, we have the opportunity (with the luxury of time) to talk to our patients without being on a strict schedule. This enables us to increase our medication knowledge and recommendations, our communication skills with patients and allows us to be proactive in teaching.

Introduction

Safe medication use is a large wheel that connects onto itself and is found to be a leading cause of injury, which are avoidable. From the transition of care to high-risk situations to polypharmacy, everybody will be involved with medications in their life, especially as the population is growing older. With so many steps between the interactions of staff, healthcare and medication system, healthcare practices put into place and the patient themselves, they are bound to be some mistakes. These are exacerbated due to healthcare workers being in a high-stress environment, tired, short-staffed, lack of monitoring and so on. Acknowledging and recognizing where mistakes can be made or have been made can ensure that these mistakes will not occur again or at least decrease its incidence and introduce protocols that can be put into place. Multiple strategies and implementations have been put into place with varying successes. For example, the World Health Organisation (WHO) has a strategic framework called Medication Without Harm which tackles and addresses the current issues. The goal is to reduce severe avoidable medication-related harm by 50%.

Below is the Medication Without Harm wheel from WHO demonstrating all the key action area and sector types where medications are involved.

Action plan & strategies

Being a medical student who will soon be in clinical years, it is important to acknowledge that I shall be involved intricately within the Medication Without Harm wheel. With ethics and moral obligations, it is crucial in being constantly professional and being aware of my actions at the hospital setting as my influences can have grave consequences, especially when it involves administering or prescribing medication. That is why healthcare professionals should always seek to improve themselves by being proactive, curious, attend seminars or conferences, becoming more aware of consequences and discuss with when there was a mistake as we can learn better from each other.

A relatively effective technique used to prevent medication administration errors is the 6 Rights of Safe Medication Administration. It describes six questions that can be mentally asked. Do I have the right patient? The right medication/dose/timing and route of administration? And the right documentation? The right documentation is interesting and a little different as it is part of ‘ongoing safe medication use’. The correct documentation enables healthcare staff to look back and know exactly what medication (dose, route of administration, frequency) were given, when it was administered and which patient was involved.

Having asked a 5th-year medical student if he had ever made a medication-related mistake, he told me he injected sterile water subcutaneously thinking it was lignocaine (which is an analgesic) with adrenaline. He assumed what was given to him in the syringe by his supervisor was lignocaine/adrenaline solution and did not communicate effectively to double-check that it was indeed lignocaine/adrenaline solution. This is a classic case of step 2 "the right medication" and a lesson that even if a colleague or supervisor gives the medication, always double-check. One of my strategies before entering my clinical years is to implement those six rights and learn them so well that I do not have to think about it due to being ingrained (just like handwashing or putting on a seat belt). 

In the Medication Without Harm wheel from the WHO, the section called "the patient and the public" is noteworthy. Medication safety does not end after leaving the hospital or the general practitioner's practice but instead is continuous. The best way to approach this is to educate, teach and bring awareness to the patient. For example, a patient can stay with a particular pharmacist and doctor so that a thorough medical history can be made or if the patient wants to change he/she should request an electronic transfer of the well-documented history. The patient can be aware of the 5 Moments for Medication Safety, which is a leaflet and can be taken home. The leaflet is meaningful and useful regarding medications. It talks about starting, taking, reviewing, removing and stoping the medications. The leaflet asks simple and basic questions for patients to think about their medications such as do I keep a list of all my medication or what is the name of this medication and what is it for? This leaflet can be produced by a medical student such as myself and empower patients in becoming more confident and comfortable with their medications.

To conclude

It is obvious at first, but medication safety is continuous. It is so easy to not think about it since your patient is not in front of you anymore; hence, you believe your job is finished. Medications go home with the patient, it gets eaten, it goes to its allocated organs with its specific mode of action, it causes side effects and so on. It is part of a patient's life as much as their diseases. Thus, I think as future health professionals, it is vital to supplement more on medication education or to make sure the patient understands the basics about their medication(s).

Recently, we had an interview with an older patient, and he mostly did not know anything about his medications. Now, there could be a lack of being interested from the patient and just trusting his doctor, but still, it is interesting. I thoroughly believe that going through the 5 Moments for Medication Safety with a patient could improve the patient's quality of life. For example, having an adequate inspection of the medications could reduce side effects, unnecessary medications, improve efficacy or improve how medications are stored (such as away from the sunlight, water, humidity, acids/base). There is an easy solution for that, a leaflet so that patients can take it home and a short 5-10 minutes side consultation, which is something I can do as a medical student. Let us be more medication conscious and educate.

Published 15th September 2020. Last reviewed 1st December 2021.

Reference

AHRQ authors. Your Medicine: Be Smart. Be Safe. (with wallet card). AHRQ website. https://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/tips-and-tools/yourmeds.html. Reviewed August, 2018. Accessed August 25, 2020.

Government of Western Australia Department of Health authors. The six rights of safe medication administration. Government of Western Australia Department of Health website. https://ww2.health.wa.gov.au/-/media/Files/Corporate/general-documents/safety/PDF/Medication-safety-resources/Six-rights.pdf. Reviewed 2018. Accessed August 25, 2020.

World Health Organization authors. 5 moments for medication safety. World Health Organization International website. https://apps.who.int/iris/bitstream/handle/10665/311157/WHO-HIS-SDS-2019.3-eng.pdf. Published March, 2019. Accessed August 25, 2020.

World Health Organization authors. Medication without harm: global patient safety challenge. World Health Organization International website. https://www.who.int/patientsafety/medication-safety/strategic-framework.pdf. Published 2018. Accessed August 25, 2020.

World Health Organization authors. The third WHO Global Patient Safety Challenge: Medication Without Harm. World Health Organization International website. https://www.who.int/patientsafety/medication-safety/en/. Reviewed, 2020. Accessed August 25, 2020.