WHO: World Patient Safety Day, 17 September 2022: Medication without harm

16 September, 2022

Read online: https://www.who.int/campaigns/world-patient-safety-day/2022 - Comment from me below.

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Medications are the most widely utilized interventions in health care, and medication-related harm constitutes the greatest proportion of the total preventable harm due to unsafe care, let alone the economic and psychological burden imposed by such harm. Acknowledging this substantial burden and recognizing the complexity of medication-related harm prevention and reduction, "Medication Safety" has been selected as the theme for World Patient Safety Day 2022.

The campaign is envisaged to provide the needed impetus to consolidate the efforts of the existing WHO Global Patient Safety Challenge: Medication Without Harm, emphasizing the need to adopt a systems approach and promote safe medication practices to prevent medication errors and reduce medication-related harm. Special consideration will be given to areas where most harm occurs. The key action areas are high-risk situations, transitions of care, and polypharmacy.

Also: https://www.who.int/initiatives/medication-without-harm

'Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally, the cost associated with medication errors has been estimated at $42 billion USD annually [*see note below]. Errors can occur at different stages of the medication use process. Medication errors occur when weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death. Multiple interventions to address the frequency and impact of medication errors have already been developed, yet their implementation is varied. A wide mobilization of stakeholders supporting sustained actions is required. In response to this, WHO has identified Medication Without Harm as the theme for the third Global Patient Safety Challenge.'

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COMMENT (NPW): I have tracked the source of this estimate of $42 billion USD annually. It is Aitken M & Gorokhovich L. Advancing the responsible use of medicines: applying levers for change. IMS Institute for Healthcare Informatics. 2012 http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2222541 This in turn refers to IMS MIDAS, 2009 and 2011; World Bank 2009; WHO 2009; USD in 2011. WHO says 'the cost associated with medication errors has been estimated at $42 billion USD annually'. However, the source data are based on six parameters, only one of which is 'medication error': 'nonadherence, untimely medicine use, antibiotic overuse and/or misuse, medication errors, suboptimal generic use, and mismanaged polypharmacy'. The estimate is based on incomplete data 2006-2011 [https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2222541]. Some aspects are unclear. Did the authors include failure to give a medicine, or giving the wrong medicine, as a result of misdiagnosis? To what extent did lack of availability of reliable information on medicines (for prescribers and users) contribute to the six parameters? To what extent did commercial interests contribute?

I also note the original source is based on 'hospital-based errors only as this is where the majority of the evidence exists'. The enormous burden of substandard use of medicines in the home and primary care setting appears to be overlooked.

Best wishes, Neil

Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines http://www.hifa.org/projects/prescribers-and-users-medicines

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information. HIFA is administered by Global Healthcare Information Network, a UK based non-profit in official relations with the World Health Organization.

Twitter: @hifa_org neil@hifa.org