Tag Archives: Royal Pharmaceutical Society

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, Health, Medical, Research, Science

A breakthrough test to tell if you really need antibiotics…

CRP TEST

A simple three-minute blood test could tell doctor’s whether a patient needs antibiotics.

Not only could this help patients avoid suffering nasty side-effects from taking unnecessary drugs, but it could also tackle one of the greatest threats to modern health – antibiotic resistance. The test tells a doctor whether the patient is suffering from a viral or bacterial infection – that way, they will know whether or not to prescribe antibiotic medication.

Antibiotics are only effective against bacteria – they do not kill viruses. Currently, the type of infection can only be confirmed with a blood test which must be analysed in a laboratory, a process that can take two to three days.

GPs say they often give antibiotics as a full-safe measure, and that patients pressure them for the pills. According to Public Health England (formerly the Health Protection Agency), if patients ask their doctor for an antibiotic, the vast majority will get one.

Over-prescribing of antibiotics has consequences both for the patient and the population. As well as causing side-effects, over-use can lead to bacteria becoming resistant, making antibiotics less effective at fighting infections. The Government’s chief medical officer has described this as ‘one of the greatest threats to modern health.’

Over the past five years alone, the number of antibiotic prescriptions has risen by 10 per cent to 41 million prescriptions at a cost of £170 million to the NHS. A third of all Britons have taken them in the past 12-months.

A simple finger-stick test could solve this ‘catastrophic threat’. The test – which involves taking a drop of blood from the finger – can tell doctors within three minutes whether an illness is caused by a bacterial infection which requires antibiotics, or a virus, which does not.

It measures a substance called C-Reactive Protein (CRP) in the blood. The amount of this protein increases when the body is fighting a bacterial infection, but not when it is fighting a virus, which triggers a different immune response.

So a doctor would know that if the CRP level was shown to be low, antibiotics would not be required.

Studies show that providing ‘proof’ that they are unnecessary to patients who demand antibiotics can significantly reduce the number of prescriptions.

One EU-funded study, presented at the World Association of Family Doctors conference in 2010, looked at how respiratory infections which are generally caused by viruses were treated by 600 GPs in six different countries. It found that antibiotic prescriptions fell by 25 per cent when doctors used the CRP test.

British scientists say the test could be a useful tool for significantly reducing antibiotic prescriptions.

A senior clinical research fellow at Cardiff University who specialises in antibiotic resistance in primary care, said:

… Unfortunately, it is very difficult to accurately determine whether an infection is viral or bacterial.

… Markers such as CRP have evolved to help where there is lingering uncertainty after a clinical assessment or where the patient has strong beliefs that antibiotics are needed.

… (However, not everyone needs the test) … Patients who appear very unwell should be treated with antibiotics or admitted to hospital without the test because they could develop complications.

… But for those patients where there is doubt, or where the GP feels antibiotics are not needed but the patient is putting pressure on to prescribe them, the test can be helpful.

The test is currently only available in laboratories in the UK (it can be carried out privately for around £50) because the NHS does not yet fund it in GP practices. The machine to analyse the test would initially cost £1,000 and then £3 per test.

A spokesman for the Royal Pharmaceutical Society says it is likely to be some time before the test is routinely available on the NHS.

… CRP testing would be a natural extension to the clinical services we offer but it will be two or three years before there is enough evidence for it to be made widely available.

Other concerns about the test are that the results are not always clear – levels of CRP also increase as a result of inflammation caused by other conditions such as rheumatoid arthritis as well as infections.

The test is deemed to be a guide and does not categorically imply that a patient has a bacterial infection if the results are synonymous with having an infection. It gives the doctor a number that has to be interpreted in light of the other symptoms and the patient’s overall risk profile.

For example, a doctor is more likely to treat an elderly person with diabetes with antibiotics than a young healthy person, as the elderly person is more likely to develop complications.

Clinical experts say the best way to reduce antibiotic prescriptions is to educate doctors and patients about common complaints and when antibiotics are necessary.

The Royal Pharmaceutical Society warns that to see this test as the panacea would be an extremely dangerous idea. The Society says it needs to work hard to educate patients about when it is appropriate to take antibiotics and by making sure they take them correctly as prescribed by finishing the course.

Public Health England adds:

… CRP may be useful in a small range of infections provided the test is robustly quality controlled.

… But nothing can replace taking a detailed patient history and thorough examination.

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Health, Medical, Research

Statins can weaken muscles and joints…

New research warns that taking statins will make you more likely to be diagnosed with muscle pain, joint disease and injuries.

Researchers found a 20 per cent increased risk of muscle problems in those patients on the cholesterol-lowering drugs compared with those not taking them.

The risk is deemed to be relatively small but it is important because millions of older patients with heart conditions take statins and their use may eventually widen to include healthy younger people.

Statins are the most widely prescribed drugs in Britain. The number of patients taking them is estimated to be as high as 8 million. There have been persistent complaints about side effects such as muscle pain and weakness.

The most serious adverse reaction of taking statins is myopathy, and affects around one in every 1,000 users. The reactions include muscle pain, tenderness and weakness. This condition can progress to rhabdomyolysis, a complete breakdown of muscle cells that can lead to kidney failure and death.

In some patients muscle weakness may persist even after stopping the drugs. And a British Heart Foundation survey found that one in three patients prescribed statin drugs doesn’t take them, partly because of the side effects.

The latest study carried out in the United States investigated the scale of illnesses linked to statins, including muscle weakness, muscle cramps and tendon diseases.

Researchers based at the Veterans Association in North Texas, Dallas, used data from the US military health care system.

Patients were divided into two equal groups: 6,967 who used statins for at least 90 days in 2005, and 6,967 non-users.

A report published by JAMA internal medicine says that statin patients were almost 20 per cent more likely than non-users to have a diagnosis of a musculo-skeletal disease, a 13 per cent higher risk of dislocation, strain or sprain, and slightly higher risk of muscle pain.

But statin users were no more at risk of joint-diseases such as osteoarthritis than non-users. The report states: ‘To our knowledge, this is the first study to show statin use is associated with an increased likelihood of diagnoses of musculoskeletal conditions, joint diseases and injuries.’ (sic)

Calls have been growing for healthy over-50s to take statins, not just those at extra risk of a heart attack. The researchers also said that any significant effect on general health, however small, needs to be carefully considered. These findings are concerning because starting statin therapy at a young age for primary prevention of cardiovascular diseases has been widely advocated.

Warnings from statin drug manufacturers’ include muscle pain and weakness, memory loss, fatigue, sleep disturbances, sexual dysfunction and depression. There is also a higher risk of developing diabetes.

Scientists in the UK say the study shows a very small impact of statins, increasing the risk of musculoskeletal disorders overall from 85 per cent in those not on statins to 87 per cent on a statin.

The Royal Pharmaceutical Society fears that more patients might stop taking the drugs. Citing that the UK has some five million people taking statins to prevent heart attacks and strokes, the Society says that if 1 per cent of these patients stop taking their statins due to concerns about muscle pains we will see at least 2,000 more heart attacks and strokes over the next ten years as a result, but avoid only 1,000 musculoskeletal problems. The Society also points out that musculoskeletal disorders occur commonly and are rarely due to taking statins.

It is argued, too, that statins save lives when used in the right type of patient – generally those at higher risk of stroke or heart attack because of other medical problems. With statins the benefits are hidden because many people who otherwise would have had a heart attack today were prevented from having a cardiac arrest because of the taking of these drugs. Doctors point out that the side effects of statins are often all too obvious, and this biases many people against a life-saving tablet.

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