World Patient Safety Day
The vast majority of health care in Australia leads to good health outcomes. However, patients do not always receive the most appropriate care and preventable adverse events can occur. The issue of patient safety has been recognised as both a national and global priority by the Australian Government and the World Health Organization (WHO), respectively.
In Australia, the most burdensome adverse events include medication complications, care-associated infections, delirium and cardiac complications. WHO has declared September 17 as World Patient Safety day. Medication without harm is WHO’s Third Global Patient Safety Challenge.
The Centre for Medicine Use and Safety performs cutting edge research to better understand and improve medication safety in a range of healthcare settings. Below are some examples of recent CMUS research that has helped to understand and improve patient safety.
Dr Cornelia Landersdorfer – Developing world first dosing regimen for antimicrobials in critically ill patients
Antimicrobial resistance is among the greatest threats to global health.
Critically-ill patients with life-threatening infections require effective and safe treatment with antimicrobials. However, dosing regimens are not always optimal for vulnerable populations with clinical factors that influence the way medicines are tolerated and move around the body (known as pharmacokinetics (PK)). This is especially true for older antibiotics not subjected to contemporary drug development processes. Improper dosing can cause medication complications.
To address this, Dr Cornelia Landersdorfer has performed mathematical modelling to understand optimal dosing of antimicrobials. Dr Landersdorfer’s research has enabled the first scientifically-based dosing regimens for the antibiotic polymyxin B.
Dr Landersdorfer’s modelling was pivotal for the determination of optimal dosage regimens, including the recommendation that doses should not be decreased in renal impairment and highlighting the importance of a loading dose.
The modelling was also able to identify patient factors that impact dose selection and predict probabilities of achieving target plasma concentration exposures for a range of regimens and Gram-negative bacterial pathogens with different susceptibilities to polymyxin B.
This research was described as a ‘landmark study’ by The Lancet and formed the foundation of dosage regimen recommendations in the 2019 International Consensus Guidelines. Dr Landersdorfer’s work has helped to understand optimisation of medicines as well as contribute to changes in policy and recommendations to improve patient safety and minimise potential adverse events due to medication complications. You can read more about this study here.
Dr Amanda Cross – Improving and preventing medication-related harms
Medicines and older people
Older people often have multiple chronic health problems, requiring multiple different medications and this can increase the risk of medication related harm. More than a third of older Australians take five or more medications, thus it is essential to support medication safety.
Dr Amanda Cross has recently published a review in the prestigious Cochrane library evaluating which types of interventions were most effective at improving medication adherence and medication taking ability in older populations taking multiple medications.
The extensive review identified 50 studies with over 14,000 participants. It found that behavioural-only or mixed behavioural and educational interventions, especially those initiated at the hospital-community or primary care interface, may improve the proportion of older adults who adhere to their medication schedules.
Examples of behavioural interventions included simplifying medication regimens, providing dose administration aids or sending text message adherence reminders. Mixed behavioural and educational interventions were also found to improve older people’s medication knowledge and reduce the number of emergency department (ED) admissions. You can read the Cochrane review here .
Medicines and people living with dementia
Dr Cross has also performed important research into identifying the primary factors hindering effective medication management for those living with dementia. This study investigated the obstacles and complexities in medication management for people living with dementia through qualitative research involving key stakeholder groups: people living with dementia and their carers, general practitioners, nurses and pharmacists.
Dr Cross found that barriers identified were: difficulty coping with changes in medication regimens, poor communication and relationships between stakeholders; infrequent medication reviews and a lack of practitioner training, evidence and guidelines to navigate prescribing and deprescribing decisions.
Dr Cross says: “Health professionals need to collaborate and communicate to help optimise medication use and patient safety. Future interventions should focus on training and evidence-based guidelines for prescribing and deprescribing in people with dementia.” You can read more about this study here.
Dr Jenni Ilomaki and Professor Simon Bell – Creating new international collaborative networks and using big data to address medication safety in vulnerable populations
The rapid increase in the availability of administrative and electronic medical records data is creating new opportunities for ‘big data’ research to improve medication safety and effectiveness. CMUS has established an international network called the Neurological and mental health Global Epidemiology Network (NeuroGEN). NeuroGEN was established in late 2018 and consists of universities from Hong Kong, Finland, Taiwan, the Netherlands, US, UK, Scotland, South Korea and Australia.
Through international collaboration, CMUS is able to conduct large, generalisable, observational studies that represents more than 100 million people. The collaborative network has received funding from Victorian Medical Research Acceleration Fund, Dementia Australia Research Foundation and Yulgilbar Foundation. NeuroGEN is investigating topics including the safety of effectiveness of medications for heart attack, stroke, diabetes and hip fracture in people with dementia. You can read more here.
More information on World Patient Safety day can be found here
More information on the research performed by CMUS can be found here