Sep 172019


Phil Routledge was, until his recent retirement earlier this year, Founding Clinical Director of the All Wales Therapeutics and Toxicology Centre (AWTTC) at University Hospital Llandough. AWTTC provides professional support to AWMSG in their aim to help to obtain the best possible outcomes from medicines for the people of Wales. He is now a member of the Medicines Safety Programme Management Board.

In June 2017, Sir Liam Donaldson, the World Health Organization (WHO) Director-General’s envoy on patient safety came to Wales to deliver the fourth Felicity Newton-Savage Memorial lecture* entitled “Medication and its Use; a Priority for Patient Safety” at the 15th Anniversary Conference of the All Wales Medicines Strategy Group (AWMSG). He recounted that just three months previously in Bonn, WHO had launched its third global patient safety challenge Medication Without Harm. The two preceding challenges had been Clean Care is Safer Care in 2005 and Safe Surgery Saves Lives in 2008. The vital importance of all such aspects of patient safety is now to be recognized internationally in the decision earlier this year by the 72nd World Health Assembly, WHO’s governing forum to designate September 17th each year as World Patient Safety Day (1). The theme for the day is “Patient Safety: a global health priority” and the associated slogan is “Speak up for patient safety.”

Medication Safety is a hugely important aspect of patient safety and WHO has agreed that the aim of Medication Without Harm will be to reduce severe, avoidable harm related to medications by 50% over 5 years, globally. They have identified four key domains involved in the challengePatients and the public, Medicines, Health care professionals, and Systems/ practices of medication. Within these domains they have chosen to focus on three key action areas, – Polypharmacy, High risk situations, and Transitions of care. Three WHO technical reports concerning these action areas have recently been published (2).

Polypharmacy is the concurrent use of multiple (i.e. more than one) medications. Although there is no standard definition, polypharmacy is often described as the routine use of five or more medications, although this includes over-the-counter (OTC), prescription and/or traditional & complementary medicines (3).  Polypharmacy may be appropriate in some cases but may also be inappropriate if one or more medicines are prescribed that are not, or no longer needed. The AWMSG Polypharmacy Guidance has produced a suite of policies to support polypharmacy management, including deprescribing (stopping medicines) when clinically appropriate (4).

Transitions of care (2) are “the various points where a patient moves to, or returns from a particular physical location or makes contact with a health care professional for the purposes of receiving health care. This includes transitions between home, hospital, residential care settings and consultations with different health care providers in out-patient facilities” (5). Although they may result in circumstances in which medication error can occur especially if communication is inadequate, they also provide opportunities for using resources such as the AWMSG Multidisciplinary Medicines Reconciliation Policy (6) and person-centred medication review.

High Risk Situations (2) are, those circumstances which are associated with a significant risk of medication- related harm, either due to medication factors, provider and patient factors or systems factors (e.g. the work environment) or a combination of these working together. The All-Wales polypharmacy guidance (4) focuses on the at-risk, the frail older person and on some of the high-risk (high alert) medications identified in the WHO technical report. Separate resources on particular high-risk (high-alert) medicines such as anticoagulants and opioids (including tramadol) are also available on the AWMSG Website.

Earlier this year Andrew Evans, our Chief Pharmaceutical Officer for Wales, commissioned 1000 Lives to develop a national Medicines Safety Programme for Wales in response to ‘A Healthier Wales’ and ‘Medication without Harm’. Paul Gimson, Programme Lead for Primary Care and Medicines Safety at 1000 Lives Improvement/Improvement Cymru is leading the development of a new Medicines Safety Cymru programme.

On this first World Patient Safety Day, Paul is asking healthcare professionals in Wales to highlight initiatives planned or already underway in medicines safety across Wales. Some of these areas (e.g. deprescribing in GP Practice and reducing anticholinergic medicines burden (7)) have already been presented to a wider audience at previous AWTTC annual best-practice days organised by AWTTC’s Welsh Analytical Prescribing Support Unit (WAPSU) but I’m aware that there are many more examples of best practice in medication safety across Wales from which we can all learn.  A range of the projects received will then be discussed at a special Medicines Safety Cymru masterclass on 26 November 2019. Please send in your project details to by 18 October 2019.

*The late Felicity Newton Savage was the first Director of the Welsh Medicines Resource Centre (WeMeReC), now part of AWTTC. She was instrumental in developing products unique to WeMeReC that are highly regarded and valued by healthcare professionals within and outside of Wales.

References/ Links

  1. World Health Organization: World Patient Safety Day .(accessed 29/08/2019)
  2. World Health Organization. Medication safety in key action areas, World Health Organization 2019. (accessed 29/08 2019)
  3. Masnoon N et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017; 17: 230 (accessed 02/09/2019)
  4. All Wales Medicines Strategy Group. Polypharmacy guidance (accessed 29/08/2019)
  5. Transitions of Care: Technical Series on Safer Primary Care. Geneva: World Health Organization; 2016. (accessed 29/08/2019)
  6. All Wales Medicines Strategy Group. All Wales Multidisciplinary Medicines Reconciliation Policy (accessed 02/09/2019)
  7. All Wales Therapeutics and Toxicology Centre: Best Practice Day 2018. (accessed 02/09/2019)

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