The second part of the Framework focuses on the processes for reducing adverse events.
IV. PrescribingBefore commencing medication, prescribers need to explain to consumers, and where appropriate carers, why initially switching and changing doses is often necessary. They should also explain how long it may take to find a medication or combination of medications that will be effective and suit the individual. Before commencing use, consumers, and where appropriate carers, should also be provided with information on possible side effects, how long they may last, how to respond to these side effects and the possibility of adverse medication events occurring in the long term with certain medications – e.g. antipsychotic medications associated with an elevated risk of tardive dyskinesia and metabolic syndrome. This advice should be provided as a supplement to the information in the CMI, as part of the supplementary document to accompany the CMI as proposed in the Section on Prevention.
There is a strong case for the development and maintenance of a national central repository of information. This would include educational materials, clinical practice guidelines, availability of health services, support groups etc. The central repository would provide information for fully informing consumers and carers of the process of commencing new medications, what to expect, what side effects are likely to occur, and how to deal with these side effects. This information could be part of a national, standardised set of information for consumers, carers and health professionals and include information on psychotropic medications. Top of page
Consumers should be involved in making decisions about their medications, and their input should be highly valued and respected. It is important to engage consumers, and where appropriate carers, to have a comprehensive discussion with health providers before they make treatment decisions. This discussion should include the consumer's health and medical history, options for treatment, benefits and risks of each option, concerns about side effects, and the appropriate response and constraints on treatments such as cost, lifestyle and family support. In addition, consumers should be educated to inform all of their health care providers about all of the medications that are being used.
GPs, Nurse Practitioners and specialists should be encouraged to:
- ask consumers, and where appropriate their carers, about all the medications, alternative treatments, alcohol and illicit substances they are using, before prescribing
- document this use and encourage consumers to keep their own record and
- advise consumers, and where appropriate carers, on possible adverse reactions and interactions including the possibility of adverse medication events occurring in the long term with certain medications. Prescribers should also pay attention to any contributory factors to facilitate early detection of such adverse events. Top of page
- Access available information, including educational and clinical practice guidelines, from central repository when established.
- Encourage consumers, and where appropriate carers, to have a comprehensive discussion with the relevant health provider about treatment options, including drug therapies, prior to prescribing a new medication.
- Encourage consumers to disclose information about all medications to all health care providers.
- Encourage health care providers to seek comprehensive information on all medications and substances being used by the consumer prior to prescribing a new medication.
- Advise consumers, and where appropriate carers, the appropriate course for reporting an adverse drug reaction. Top of page
V. DispensingPharmacists should also ensure a thorough discussion with consumers prior to dispensing medications. Specifically, they should ask consumers (in a setting that ensures privacy) about complementary, over-the-counter and prescription medicines they are using, before dispensing medications, and advise consumers on possible adverse effects and interactions including, as stated above, the possibility of adverse medication events occurring in the long term with certain medications Any queries regarding the prescription, including possible errors in the prescription, should be clarified with the prescriber prior to dispensing.
Pharmacists, together with other health professionals, should be encouraged to reduce the number of medicines and doses that consumers have to take e.g. combination medications and slow-release tablets. Packet information and labels for medications should be legible and easily understood – for example, pharmacists should ensure they do not cover important information on the packaging with their own pharmacy stickers.
It is important to recognize a consumer's possible confusion about generic and brand name medicines. After consulting with the prescriber, the pharmacist should provide an explanation of the pros and cons of the use of these medicines to consumers, and where appropriate carers. The pharmacist has a role in communicating with other health professionals to minimise any consumer confusion prior to dispensing medications. It is vital that CMI and the proposed supplementary information discussed in Part 1 is provided to the consumer. Top of page
Consumers, and where appropriate, with the support of their carers, should be encouraged to persist with their medications and to discuss any side effects with their doctor.
It is noted that medication management is the subject of review by a number of bodies including in the context of Quality Use of Medicines, by consumer and carer organisations and by professional bodies such as the Pharmacy Guild of Australia. These initiatives will contribute to improving medication safety on an ongoing basis and should be regularly incorporated into local and centralised medication management policies.
- Engage in a comprehensive discussion with consumers about all medications they are using, including prescription, over-the-counter and complementary.
- Consider and recommend drug modalities that ensure better compliance, including minimising frequency by considering slow release drugs.
- Ensure all information is legible and highlighted to the consumer.
- Minimise confusion between brand name and generic medicines.
- Encourage perseverance with medication.
- Advise consumers, and where appropriate carers, to monitor, and course for reporting, an adverse drug reaction. Top of page
VI. ReportingDespite the work that has already been conducted, national data on the incidence of adverse medication events is limited. The reporting of adverse medication events outside the hospital setting is at a low level and there is a need to enhance a community reporting system as much as the hospital system.
The Adverse Drug Reactions Advisory Committee (ADRAC), a subcommittee of the Therapeutic Goods Administration, which advises on the safety of medicines, maintains data on adverse reactions. However, this data is reliant on how comprehensively and consistently these incidents are reported. There is recognition that reporting to ADRAC needs to be improved.
The National Prescribing Service (NPS) Adverse Medicine Events (AME) Line is another avenue for reporting adverse reactions which specifically targets reporting by consumers. The AME Line is not well used and therefore the data is not representative of the adverse medication events that are occurring in the community. It is understood that the NPS will continue to work in this area. Top of page
In general reporting mechanisms at present are insufficient to represent the incidence and prevalence of adverse medication events. Available studies suggest that electronic reporting is a most effective way to overcome these difficulties. In the interim, consumers and carers and all health professionals involved in the prescribing/ dispensing chain, should be encouraged to report adverse medication events to the relevant local authority and ensure that this information is conveyed to ADRAC and AME. This will include reporting the incidence of adverse medication events that occur in the long term. This may present problems because of the time lapse before the adverse event becomes apparent and this will require constant reinforcement of the need to report such events as soon as possible, analyse the information and present the findings.
More education and awareness is required at a national level about what reporting mechanisms are available and means of access. The NPS has a major role in educating consumers, carers and health professionals about the use of medications and also encouraging consumers and carers to report adverse medication events. To date, in mental health, this has primarily been focussed on the use of antidepressants. A greater focus by the NPS on educating consumers about reporting adverse medication events may require increased resources, particularly if this is to ensure accommodating the specific needs of Indigenous consumers and carers and those from culturally and linguistically diverse backgrounds.
- Improve education and awareness of the benefits of reporting adverse medication events, the mechanisms available and means of access for reporting. Top of page
VII. AdministrationThere is current activity, at both national and jurisdictional levels, around development of standard procedures and medication record for consumers' medication details at admission. A standardised system would minimise duplicate recording of those details and may contribute to decreasing medication errors due to variation across settings. National consistency around education, training and protocols for the use of a 'Standard Medication Record' would further enhance medication safety.
Current work around medication conciliation may include one-step recording of medication at admission. It is important to develop a way to ensure that all those people with an interest in administering medications (consumers, carers, nurses, clinical assistants, hostel supervisors and others) are able to do so safely. Recognising the complexity of the consumer journey through the healthcare system, it is important that the consumer has a record of his/her current medications to accompany him/her when seeing a new health professional. In particular, accurate and timely transfer of medication history is critical at the handover points in care.
The development of a national Standard Medication Record is seen as a significant contributor to improving safety and quality in administration of medications generally.
- Promote development of a 'Standard Medication Record' to support improved medication safety.