Prescribing in 2019: what are the safety concerns?

ABSTRACT

Introduction: Unintended harm from prescribing errors remains a prevalent concern in healthcare leading to significant morbidity and mortality around the world. Prescribers face new challenges to their practice in modern times such as increasingly complex health-care systems, an aging population with increasing multimorbidity, and rapid growth in the number of novel medicines.

Areas covered: Prescribing concerns in modern practice are outlined based on seminal literature in this area and the author’s continual academic oversight of this topic. Major UK and international reports have been used to highlight the important emerging issues in prescribing, and focused literature searches performed to highlight key papers supporting this review.

Expert opinion: Whilst there are many ways to consider mitigating the risk of harm from prescribing, it is suggested that a tripartite approach is required. Patients and carers are essential partners in the process and shared decision-making has replaced paternalistic practice in achieving joint prescribing decisions. Comprehensive and coordinated care is critical to avoid fragmented care and poor transfer of prescribing information. Lastly, a whole systems approach is crucial to ensure that all prescribers are supported (and not overwhelmed) when making safe, effective and timely prescribing decisions.

KEYWORDS:

• Prescribing
• medication safety
• medicine
• pharmacist
• inappropriate prescribing
• polypharmacy
• drug misuse
• interprofessional communication
• deprescribing

Article highlights

• Unintended harm or injury experience by patients due to prescription errors remains an ever-present concern in modern health care

• The World Health Organization has made ‘Medication without Harm’ the third global patient safety challenge aiming to reduce severe avoidable medication-related harm by 50% over five years

• The increasing complexity of health care puts a lot of demands on health-care professionals in the whole patient care process which includes diagnostic uncertainty prior to effective treatment planning

• The aging population leads to co-morbidities and potentially inevitable polypharmacy, much of which is appropriate; however, the issues of problematic polypharmacy remains important due to unintended drug–drug interactions and adverse drug reactions

• Deprescribing – the supervised withdrawal of inappropriate medication – is an important method to decrease the risk of drug-related harms

• As well as enhancing prescriber education, and better comprehensive care systems, involving and empowering the patients we treat is essential to minimize the risks of harm from prescribed medicines.

This box summarizes key points contained in the article.

Declaration of interest

JJ Coleman is a member of the Commission of Human Medicines (CHM), but the views expressed in this publication are those of the author and not necessarily those of the NHS, the University of Birmingham, the MHRA or the Department of Health. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded