World Patient Safety Day: advancing medication safety

On World Patient Safety Day (17 September 2022), the British Pharmacological Society reflected on the role of clinical pharmacology in advancing medication safety. 

Clinical pharmacologists are experts in the development and use of medicines. They investigate the mechanism of action of potential therapeutics, working to translate these into clinical use through the design and delivery of innovative trials, and ensuring safety and effectiveness through regulatory evaluation and pharmacovigilance. They help to ensure that individual patients receive the best treatment—‘precision medicine’; for example, through stratified trials and pharmacogenomics. They drive education in therapeutics, and work on the frontline as general physicians who take an integrated approach to patient care.  

Central to clinical pharmacology is deciding how to obtain the maximum benefit while minimising harm. Clinical pharmacology, as part of a multi-disciplinary team, has a critical role to play in reducing the risk of medication error, injury and preventable harm - through research, education and clinical practice. 

Research 

The development of new drugs, their introduction into clinical practice, and the surveillance of their beneficial and harmful effects throughout their usage are carefully regulated in the UK. Clinical pharmacologists play a vital part in the study of new drugs and in the regulatory bodies responsible for their introduction and surveillance to make them as safe and effective as possible. [Further reading: An agenda for UK clinical pharmacology: UK medicines policy: the role of clinical pharmacologists]  

For example, UK clinical pharmacologists played a central role to the COVID-19 response, with contributions that span research design, discovery, development and delivery (for example, through running national platform trials like RECOVERY and developing potential interventions including monoclonal antibodies and vaccines), regulatory decision-making (for example, through rapid approval of COVID-19 vaccines), and patient care.

Clinical pharmacologists are at the forefront of pharmacogenomics – the study of how genes affect a person’s responses to drugs – and of advocating pharmacogenetic testing to target treatments. The report ‘Personalised Prescribing: using pharmacogenomics to improve patient outcomes’, published in March 2022 by the British Pharmacological Society and the Royal College of Physicians, highlights the importance of pharmacogenomic testing in ensuring patients have an equal chance of being prescribed a medicine at a dose that is likely to be safe and effective for them, minimising side effects and maximising benefits. 

Education 

Clinical pharmacologists have a major role in teaching the elements of safe prescribing. 

All UK medical students are required to sit the Prescribing Safety Assessment (PSA). Developed and delivered by the British Pharmacological Society and Medical Schools Council, the PSA allows all students to demonstrate their competencies in relation to the safe and effective prescribing of medicines. Doctors and pharmacists continue to work together collaboratively to ensure the best possible validity and standards of assessment. The PSA is central to ensuring that medication is prescribed safely and correctly, thereby reducing medication-related harm. 

BPS Assessment supports the work of doctors, nurses, pharmacists, dentists, students and educators worldwide by identifying knowledge gaps and creating high-quality learning and assessment materials in collaboration with subject experts. Its aim is to give prescribers the skills and knowledge they need to achieve better prescribing and better patient safety. Following World Patient Safety Day 2021, a new assessment was developed, focussing on safe prescribing for those who are pregnant or breastfeeding. The MHRA – Pregnancy and Breastfeeding Assessment, developed in collaboration between BPS Assessment and the MHRA Safer Medicines in Pregnancy and Breastfeeding Consortium, is free to access on the BPS Assessment platform.  

At postgraduate level, clinical pharmacologists and their colleagues provide education to healthcare professionals through a suite of online training programmes called SCRIPT.

Clinical practice 

Patients are now prescribed more medicines than ever before, increasing the risk that medicines will interact and cause unexpected or harmful effects. Furthermore, as the population ages, people accumulate more co-existing chronic diseases (multimorbidity), necessitating the use of multiple medicines (polypharmacy) – over 1 million people in the UK take eight or more medicines per day. Clinical pharmacologists are beginning to tackle the problems of polypharmacy and are increasingly called on to simplify and rationalise treatments in patients whose conditions are hard to treat. [Further reading: Development of a structured clinical pharmacology review for specialist support for management of complex polypharmacy in primary care] 

In conclusion 

Most clinical pathways involve medicines. They represent the highest area of spend (after workforce) across the NHS, estimated at £20.9 billion per year and growing more than the current annual increase in funding. Reducing the overprescribing of medicines and ensuring the best outcomes and value from them is a strategic priority for the NHS.  

Over 1.1 billion prescription items are dispensed in the community every year and although medicines have many proven benefits, they can also cause harms.

About 90% of drugs only work in 30-50% of patients prescribed them, and 6.5% of all hospital admissions are caused by adverse drug reactions. Two-thirds of medicines-related hospital admissions are preventable. 

Medicines will be at the heart of the challenges and opportunities we face as a society in the coming decades. The increasingly personalised nature of research and care, the opportunity of a thriving clinical science and innovation base that can deliver transformative treatments, combined with the complexity of polypharmacy means that clinical pharmacology is needed now more than ever. Moreover, clinical pharmacologists will have their greatest impact as part of multi-professional teams that bring complementary skills to delivering safe and effective medicines to patients. That’s why the Society, together with partners in the Clinical Pharmacology Skills Alliance, Health Education England and NHS England, are calling for investment in a partnership between clinical pharmacology and pharmacy as part of integrated medicines services across the UK.  

Truly delivering medication as safely and effectively as possible means investing now in the medicines workforce for the future.  

The Society would like to thank Professor Robin Ferner for his contribution to this blog.

Comments

If you are a British Pharmacological Society member, please sign in to post comments.