Government, Health, Medical, Scotland

NHS drug bungles. Care home patients often receive ‘wrong’ medication…

ERRORS IN MEDICATION

Thousands of elderly care home patients are subjected to errors in their medication.

On any given day, seven out of ten residents are given wrongly administered drugs.

The errors, by care home staff, doctors and pharmacists, include giving the incorrect dosage, not giving drugs at the correct time or ensuring patients take their drugs.

Such mistakes can lead to adverse reactions, emergency hospital admissions and even death.

The Scottish Government’s Review of NHS Pharmaceutical care of Patients in the Community in Scotland noted that care homes residents have multiple ailments and complex drug regimes, but said:

… Seven out of ten residents receive some form of medication error each day.

Experts have agreed that action must be taken to address a ‘ticking time bomb’ as thousands of older patients face admission to care homes.

They said ‘poor medicines management’ is the reason for many errors and they called for regular input by pharmacists into patient care.

The Royal Pharmaceutical Society in Scotland has set up a working group to examine how pharmaceutical care in care homes could be improved.

Critics described the findings as ‘deeply worrying’ and called for urgent action to ensure the safety of patients.

A spokesperson for the Royal Pharmaceutical Society, said:

… Patients are extremely vulnerable when they transfer from one care setting to another and records do not always follow the patient or go to the community pharmacist.

… There is a need for sharing of information to one single electronic patient record.

According to the review, as the country’s population ages, and patients live longer with medical complications, there are likely to be ‘major challenges for pharmaceutical care in the future’.

After looking at the needs of residents in care homes, experts also found that most medication errors are caused by doctors or pharmacists.

The report found:

… The increasing dependency and multi-morbidity of residents, many with dementia, requires high quality pharmaceutical care, to meet the medication needs of individual residents.

The Royal Pharmaceutical Society added that the ‘time bomb’ is one of demography, saying that we have increasing numbers of elderly people with several long-term conditions and, to accommodate this, there is a need to develop more integrated care solutions.

In response to criticism that errors are occurring so shockingly frequently, and that everyone must get round the table to work out how this may be sorted, a Scottish Government official said:

… We are looking at ways to improve pharmaceutical services by working with GPs, the NHS and professional bodies.

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Britain, Government, Middle East, Military, Russia, Syria, United States

The military options the West has in smashing Assad’s arsenal…

MILITARY OPTIONS

UK and US military commanders are drawing up a list of targets for precision-guided bombs and missiles to strike at the heart of Bashar al-Assad’s Syrian regime. The options are examined:

… What targets would the coalition hit?

THE favoured option among military commanders is for limited Western action using ‘stand-off’ weapons from long distance to disrupt Assad’s ability to carry out chemical attacks and damage his military machinery.

Intelligence on targets would come from pilotless drones patrolling the skies above Syria and Special Forces on the ground.

Military analysts believe an attack could last between 24 and 48 hours and would target key regime installations in punitive strikes.

These would include Syria’s integrated air defence system, command and control bunkers, communications hubs, government buildings, missile sites and Assad’s air force.

The dictator’s use of air power has been a huge advantage for the regime, and eliminating or weakening it would tilt the odds toward the rebels.

Other military options are airstrikes on Syrian units believed to be responsible for chemical attacks. Reports last week claimed the chemical weapons were fired by the 155th Brigade of the 4th Armoured Division of the Syrian Army.

The division, which has a military base in a mountain range west of Damascus, is under the command of the president’s brother, Maher Assad.

… What bases would be used?

US-LED strikes would be launched from warships or submarines patrolling in the eastern Mediterranean or Persian Gulf, or from combat fighter aircraft that can fire missiles from hundreds of miles away.

A US Navy battlegroup including four destroyers is already in the eastern Mediterranean and has moved closer to Syria in preparation for action.

They are armed with Tomahawk cruise missiles capable of hitting a target from up to 1,200 miles away. Around 124 of the 18ft-long, £300,000 warheads were fired by US and British forces against Colonel Gaddafi’s forces during the Libyan war.

The US Air Force could also send B-2 stealth bombers to pound Assad’s military installations. Based in Missouri, they can cover the entire world with just one refuelling. The most expensive aircraft ever – at a cost of £600million each – they are almost invisible to radar and can carry 40,000lbs of bomb payload.

As well as having F-16 fighter jets and refuelling aircraft based at airfields in the Middle East, the US also has defensive Patriot missile batteries positioned in Jordon, which neighbours Syria.

… What firepower can Britain offer?

DESPITE multi-billion pound cuts to the defence budget that have seen military chiefs axe fast jets, warships, spy planes and 30,000 troops, the armed forces can still contribute to an assault on Syria.

The Royal Navy could fire Tomahawk missiles from its nuclear-powered Trafalgar-class submarines – one of which is constantly on patrol in the Middle East. The submarines are capable of carrying a giant payload of the super-accurate missiles.

Heavily-armed RAF Tornados could fly from RAF Marham in Norfolk to attack targets in Syria, a 4,200 mile round trip – or be deployed to Cyprus to launch bombing raids from there.

Carrying precision-guided Storm Shadow missiles, the air crews could devastate enemy defences including radar stations, anti-aircraft batteries and supply lines.

The Storm Shadows have a range of more than 150 miles, allowing the aircraft to attack targets deep inside enemy territory without getting too close to anti-air defences.

The 1,300kg missile, which technicians programme with the target details before the mission, then use hi-tech GPS systems and terrain-following equipment to fly low under radar to its destination point.

Despite being fired from as far away as 150 miles, the Storm Shadow is accurate to up to 6ft, reducing collateral damage.

… What are the dangers?

THERE are enormous risks associated with any military action in Syria.

Assad has built-up formidable air defences, supplied by Russia, which are capable of downing a US or UK fighter jet.

There are also the dangers of collateral damage from airstrikes, such as accidentally killing or injuring civilians and handing the regime a propaganda victory.

And if missiles targeted Syrian chemical plants, leaving them without protection, there is a risk of deadly nerve agents and other substances falling into the hands of terrorists – allowing them to launch a potentially catastrophic attack on the West.

… What would happen next?

MILITARY leaders are concerned that a series of ‘stand-off’ strikes will be the first step on a path that leads to full involvement in the Syrian conflict.

General Martin Dempsey, chairman of the US Joint Chiefs of Staff, warned this week that airstrikes ‘would not be militarily decisive, but it would commit us decisively to the conflict’.

His words echoed those of General Sir David Richards, who last month stepped down after three years as Chief of the Defence Staff. General Richards said the UK must be prepared to ‘go to war’ if it wanted to stop the bloodshed inflicted by Assad and stop his chemical weapons falling into the hands of Al-Qaeda militants.

But his remarks fuelled concerns about ‘mission creep’, saying: ‘If you wanted to have the material impact in the Syrian regime’s calculations that some people seek… you have to be able, as we did successfully in Libya, to hit ground targets … You have to establish a ground control zone. You have to take out their air defences. You also have to make sure they can’t manoeuvre, which means you have to take out their tanks and armoured personnel carriers.’

… How will Russia and Iran react?

DESPITE the chemical attack violating one of Barack Obama’s ‘red lines’ he is not gung-ho for military action.

He and David Cameron are keenly aware of the danger of inflaming tensions in the Middle East, where Syria has two powerful allies in Russia and Iran.

Russia has urged Assad to co-operate with a probe by UN inspectors but claims there is growing evidence Syrian rebels were behind the attack.

The Kremlin, which has defiantly blocked any action against Syria by the UN Security Council, has also hit out at ‘unacceptable’ calls for the use of force against the regime in Damascus.

The West is also at pains to not become embroiled in a proxy Cold War over Syria: without a nod from Russia, whether in public or in private, it would be problematic to act against Syria.

Iran has already spoken strongly against any intervention in Syria.

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Britain, Finance, Government, Middle East, United Nations, United States

Armed intervention in Syria is an agonising decision…

WESTERN INTERVENTION IN SYRIA

Western military intervention in Syria is moving closer. America’s reluctance to admit that its ‘red line’ had been crossed, said yesterday that there was ‘very little doubt’ that Bashar al-Assad’s forces had killed up to 1,500 civilians in a chemical attack last week. This followed statements from Britain that the only ‘plausible explanation’ for the deaths was an attack by Syrian government forces, and from France who said that a ‘reaction with force may be necessary’ if this is proved to be the case.

Though Damascus has belatedly signalled that UN inspectors can access the site of the attack, its prevarication over the last 6-days to allow inspectors in, means the evidence will have deteriorated or possibly even disappeared altogether.

The outcome of military intervention – most likely air strikes or cruise missile attacks from the U.S. naval fleet operating in the region – is impossible to predict. The threat to stability posed by the Syrian regime must now take account of the use of chemical weapons which violates international law, which implicitly undermines the authority of the UN. Whilst President Obama correctly identified it as a line which could not be crossed with impunity, failure to hold the Assad regime to account will only encourage more of the same. Mr Assad is known to have stockpiles not only of sarin gas, but also of the much more potent and deadly vx nerve gas, both types of chemical nerve agents having been moved around at will in the past few months. The strain is intensifying with refugees amassing on the borders with Jordon and Lebanon. Over the weekend, the UN declared that more than one million children have now been displaced in Syria.

The strategic risks of doing nothing are horribly clear. Armed intervention in a disintegrating Syria is an agonising choice, because the domino effect is an important factor in the equation – Iran, for example, will take heart in its pursuit of a nuclear warhead, which would possibly prompt others to follow suit in a Middle East nuclear arms race, including Israel moving closer towards unilateral military action against Tehran’s uranium enrichment programme.

One may hope that the acceptance by Syria’s backers, Russia and Iran, that chemical weapons have been used will lead to a unanimous Security Council resolution at the UN which will force Assad and his opponents to the negotiating table. That hope may well remain a pious one.

Last week’s hideous images of gassed children mean something must now be done. There can be no further delays, and contingencies should be activated in dealing with the flood of refugees pouring over the Lebanese and Jordon borders: quotas, for instance, should be drawn up in granting many of them asylum – as happened in Indochina after the fall of Saigon in 1975. A humanitarian and emergency response is now desperately needed.

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