World Patient Safety Day: supporting medicine safety with digital tools
A vast number of people take prescription medicines. In 2020, patients worldwide were expected to receive 4.5 trillion doses of medications, with over half of the global population consuming more than 1 dose of medicine per day [IMS Institute for Healthcare Informatics].
Clearly, medicines are an essential part of healthcare. However, when used incorrectly, they can also be a leading cause of harm.
At least one in 20 patients worldwide experience preventable harm in medical care, the biggest cause of which is incidents related to medicines [Panagioti et al]. In fact, it is estimated that medication-related harm accounts for half of overall preventable harm in medical care [Hodkinson et al 2020]. This could include prescribing errors, which may lead to the incorrect drug or dose being taken by a patient, or adverse reactions caused by interactions between drugs [Hodkinson et al 2020].
Incidents like these can occur due to a range of factors, including miscommunication between clinician and patient, errors in prescribing or administration, and patients taking their medication incorrectly.
Medicines optimisation is a particularly important issue among elderly patients, who may be taking multiple medications, each with different directions. Medication-related errors are the most common safety errors in older people [Mira 2019], with one study of elderly patients admitted to hospital finding an average of almost 1 medication error per patient [Bahrani et al].
Alongside educational initiatives and changes to practices around medicines use, digital tools can play a critical role in helping to ensure that medicines are used safely.
More communication makes for safer medicines
Digital tools play an important part in safe medicine use by enabling greater communication between clinicians and patients.
Regular patient communication is particularly important for medicines adherence – a key component of safe medicine use. In the US, between one-third and two-thirds of all medication-related hospitalisations are the result of people not using their medications as instructed [Brown and Bussell, 2011].
Digital tools make clinician-patient communication easier by allowing patients to receive notifications about their treatment, respond to surveys about their state of health and receive virtual clinician visits, all from the comfort of their own home.
At Huma, our medical device platform is used for healthcare, research and to run companion apps, providing near-real time visualisation of data to increase safety. Universities, pharma and medtech use the platform to run decentralised clinical trials (DCT).
In June 2022 research was published about a DCT for atrial fibrillation patients [Sarraju et al] that we helped conduct, where participants took part using our app that monitored vital signs including blood pressure and ECG data. Participants were also able to engage with clinicians directly through surveys and secure televisits.
Participants were very engaged, completing 99% of ECG and blood pressure requests, 85% of surveys and 91% of televisits. Perhaps most significantly, patients who were previously struggling to stick to their medication regime saw a significant improvement in medication adherence at 6 months, and medication adherence can play a big role in patient safety.
As this study shows, digital tools mean patients and clinicians can interact outside of scheduled clinic visits, which can support broader patient safety goals. Patients also appreciate this more convenient mode of communication – in our study [Sarraju et al], 86% of patients said they would be willing to take part in a much longer version of our clinical trial.
Supporting clinical decision-making
Many digital tools support remote patient monitoring (RPM) which gives clinicians a more complete picture of a patient’s health than in-person consultations alone, which may be infrequent.
At Huma, our RPM technology allows clinicians to monitor patient symptoms and vital signs remotely, so they can make the right decisions at the right time.
In a recent pilot program in Wales, UK, we demonstrated the power of this technology for medicines optimisation and patient safety. The 12-week pilot included 40 cardiac patients, who were able to share a range of data through their smartphones, including blood pressure, heart rate, and symptoms.
As well as streamlining the process of medicine optimisation, reducing the time needed to optimise patients’ medications by 80% and cutting outpatient appointments by almost 20%, the scheme helped to protect patient safety.
Across the trial, the service identified 82% of escalated cases due to data in the app and helped 10% of patients to avoid being admitted to hospital.
One patient, Alun Morgan (80), told the BBC that the technology protected him from medicine-related harm. “[The doctor] rang me up and she said, ‘those new tablets that you’re going to start tomorrow morning, stop. Don’t do it because your blood pressure is consistently too low.’ As far as I’m concerned, I’m on a daily check-up now without having to move from the house.”
Empowering patients, supporting clinicians and improving safety
Digital health tools give clinicians increased access to patient data, helping to keep patients safe outside of the hospital environment. And by giving patients access to information on their condition too, allowing them to track their signs and symptoms over time, patients feel empowered and involved in their care, including the decisions made about their medicines.
At Huma, we are committed to developing evidence-based, digital-first healthcare that supports patients and clinicians working together for better health. After all, it's when clinicians and patients work together that the best decisions are made [NICE 2016].
Global Use of Medicines in 2020. Report by the IMS Institute for Healthcare Informatics. https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/global-medicines-use-in-2020
Panagioti, M., Khan, K., Keers, R.N., Abuzour, A., Phipps, D., Kontopantelis, E., Bower, P., Campbell, S., Haneef, R., Avery, A.J. and Ashcroft, D.M. (2019). Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ, 366, p.l4185. doi:10.1136/bmj.l4185.
NICE (2009) Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence (CG76). www.nice.org.uk/guidance/cg76
Mira, J.J. (2019). Medication errors in the older people population. Expert Review of Clinical Pharmacology, 12(6), pp.491–494. doi:10.1080/17512433.2019.1615442.
Bahrani, L., Eriksson, T., Höglund, P. and Midlöv, P. (2014). The rate and nature of medication errors among elderly upon admission to hospital after implementation of clinical pharmacist-led medication reconciliation. European Journal of Hospital Pharmacy, 21(3), pp.156–160. doi:10.1136/ejhpharm-2013-000403.
NICE (2015) Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. https://www.nice.org.uk/guidance/ng5
Sarraju, A., Seninger, C., Parameswaran, V., Petlura, C., Bazouzi, T., Josan, K., Grewal, U., Viethen, T., Mundl, H., Luithle, J., Basobas, L., Touros, A., Senior, M.J.T., De Lombaert, K., Mahaffey, K.W., Turakhia, M.P. and Dash, R. (2022). Pandemic-proof recruitment and engagement in a fully decentralized trial in atrial fibrillation patients (DeTAP). npj Digital Medicine, 5(1). doi:10.1038/s41746-022-00622-9.
WHO (2003) Adherence to long-term therapies: Evidence for action. https://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf?sequence=1
Brown, M.T. and Bussell, J.K. (2011). Medication Adherence: WHO Cares? Mayo Clinic Proceedings, 86(4), pp.304–314. doi:10.4065/mcp.2010.0575.
Royal Pharmaceutical Society (2013) Medicines Optimisation: Helping patients to make the most of medicines. Good practice guidance for healthcare professionals in England. https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Policy/helping-patients-make-the-most-of-their-medicines.pdf
Hodkinson, A., Tyler, N., Ashcroft, D.M., Keers, R.N., Khan, K., Phipps, D., Abuzour, A., Bower, P., Avery, A., Campbell, S. and Panagioti, M. (2020). Preventable medication harm across health care settings: a systematic review and meta-analysis. BMC Medicine, 18(1). doi:10.1186/s12916-020-01774-9.
NICE (2016). Patients should be more involved in decisions about their care, says NICE | News and features | News | NICE. [online] NICE. Available at: https://www.nice.org.uk/news/article/patients-should-be-more-involved-in-decisions-about-their-care-says-nice.
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