Taking medicines is the most common way that we attempt to stave off or treat illness. Every day people all across the world use medicines to help improve their health and wellbeing. They’ve transformed the treatment and outlook for many diseases, helping people live longer and healthier lives. Yet medicines are also a major risk to patients’ safety. And this risk is not only a result of drugs’ side effects.
Mistakes in the treatment process can also lead to patient harm. Errors can happen at any stage of the pathway; when professionals prescribe, dispense and administer drugs. In England alone, it’s estimated that over 230 million such errors occur every year, causing hundreds of deaths and contributing to thousands more. And the figure worldwide is just as grim. Medication errors cost countries across the world $42 billion annually.
That’s why our researchers want to make medicines safer, and their latest research highlights a remarkably simple solution that could help towards this goal. Published in BMJ Quality and Safety, they’ve found that basic tools for patients to record their own medication information – like paper ‘passports’ and mobile apps – could help to lower some of the risks associated with medicines. Encouraging more people to use these simple interventions could lead to greater patient empowerment, the researchers say, and enhance the safety of their care.
Obstacles to ownership
When patients move from one care setting to another – for example transitioning from hospital to the community – mistakes can happen in their care. Often this is because the systems aren’t well joined-up, meaning that patients’ information isn’t transferred properly. When this happens, patients are sometimes relied on to recount their own medical details to fill in the gaps. Not only is this frustrating for patients, but it leaves room for error if they forget certain bits of information, such as details of the medications they’re taking.
Supporting patients or their carers to be more involved in their medication could potentially help the flow of information during this process, and therefore lower some of the risks associated with transitions of care. One approach to facilitate such patient empowerment is the use of tools that our researchers refer to as ‘PHIMed’, or patient-held information about medicines. These could be a written record of their current and past treatment history, or digital apps that store the same information.
Previous research has identified some of the barriers to using PHIMed, but our researchers wanted to know more about them. They also wanted to better understand how these tools could help reduce the risks of medication errors happening.
Professor Bryony Dean Franklin and Dr Sara Garfield led the research. They interviewed two groups of patients and carers, and 16 healthcare professionals, including doctors, nurses, pharmacists, dentists and opticians. They next interviewed 60 people who use PHIMed. The research team then combined this information with existing literature to come up with a list of the most desired features of these tools, and tested several commonly used ones – both digital and paper – with a group of people to see if they matched up to people’s needs.
Finding the right match
The researchers found that many patients and carers don’t use PHIMed. People often didn’t realise the need for these tools, because they believed that accurate and up-to-date information about their medicines would be automatically available. “We were surprised that people thought healthcare information systems were all connected,” said Prof Franklin, who leads IGHI’s medication safety research. “Participants quickly considered carrying information about medicines when they found out they weren’t.”
But people who did already use PHIMed found these tools to be very helpful – as did healthcare professionals. The researchers found that patients and carers used a wide range of both paper and digital tools – from medicine passports and medical alert cards, to making notes on smartphones or using health apps. Although people generally used paper tools, the work highlighted how different people have different needs and preferences and that no single tool matched everyone’s wish list of key features.
“We found different types of PHIMed are likely to be best for different people – there’s no ‘one-size-fits-all’ solution that we should be recommending,” said Dr Sara Garfield. “Instead, it’s more important that people find a solution that works for them.”
Joining the dots
Importantly, the work also identified how these tools can help make medicines safer. Users and professionals reported that PHIMed helped ensure a complete and accurate list of medicines. By filling in gaps in patchy records, they smoothed the process of information transfer between care settings. They also seemed to empower patients to take ownership of their health, enabled better monitoring of conditions over time, and allowed patients and professionals to track whether medicines were working or not.
On top of this, one scenario where PHIMed may be particularly important is in emergency situations. In these cases patients may be unable to communicate with professionals and their carer may not be present to do so.
A step towards safer medicine use
As such a simple way to enable better communication about medicines, and therefore facilitate their safe use, the researchers hope that research like this will help to promote the benefits of PHIMed and encourage their uptake.
“We need to raise awareness of the purpose and value of carrying PHIMed among patients, carers and healthcare professionals alike,” said Prof Franklin. “Our findings suggest that many more people may be willing to carry it if they knew how helpful it could be.”
But such endeavours should avoid a bias towards one type of tool over another. Instead, they should empower patients and carers to find a method that works for them.
“Everyone is different, so we need to help patients to find the PHIMed tool that best suits their needs,” added Dr Garfield.
“PHIMed isn’t a panacea for medication errors. But it is one small step that we hope more people will take to enhance the safety of their healthcare.”