Written evidence submitted by Mr Hement Patel (PHS0258)

Medicines-induced Iatrogenic Diseases:

Any unintended or unexpected incident occurring as a result of taking prescribed medicines, which could have or did lead to harm for one or more patients receiving NHS care

A submission to: Inquiry - Prevention in health and social care, UK Parliament

Introduction: Hemant Patel, Past-president, Royal Pharmaceutical Society of GB and socially responsible citizen of the UK.

Reason for submitting evidence: To make Britain the safest place to receive prescribed medicines.

Iatrogenic Disease refers to symptoms induced in a patient by a clinician’s's activity, manner or therapy. It is used especially for a complication of treatment. Iatrogenic diseases may be induced by or attributed to clinician’s themselves, or the medicines, drugs and treatments they prescribe.

In March 2017 the World Health Organisation (WHO) launched their third global patient safety challenge ‘Medication without Harm’ (Medication Without Harm (who.int) ).

The goal is to reduce severe, avoidable medication-related harm globally by 50% over the next 5 years.

INCIDENCE 

It is estimated that 5% of the 8.5 million patients admitted to hospitals in England and Wales each year experience preventable adverse events, leading to an additional three million bed days. About half of the adverse events would have been preventable with current standards of care. More than one million hospital admittances each year in the UK are because of medical errors, incompetence or the side-effects of treatment. Much of the damage is caused by careless or inappropriate prescribing, or overprescribing. This means the clincians rate alongside cancer and heart disease as a major cause of serious illness and death.

A study by research team from University College London (2001) estimated that one in 14 British patients suffers some kind of "adverse event" during hospital stays. One in ten of all hospital patients is harmed by complications, half caused by clinical mistakes of some kind, and almost 70,000 a year die partly as a result of such "adverse events".

Nearly 28,000 written complaints are made about aspects of clinical treatment in UK hospitals each year. The National Health System (NHS) pays out around 4 million pounds a year for settlement of clinical negligence claims, and has potential liability of around 2.4 billion pounds for existing and expected claims.

Medicines-induced Iatrogenic diseases

1)      Medicines are poisons, with beneficial effects.

2)      All therapeutically effective medicines have side effects.

We must weigh the benefits of any treatment against the risks.

3)      Medication errors are any ‘patient safety incidents’ where there has been an error in the process of

1. Prescribing
2. Preparing
3. Dispensing
4. Administering
5. Monitoring
6. Providing advice on medicines

4)      Cost of medication errors

Research evidence indicates the following error rates in the medicines use process

1. Prescribing error rate in hospital 7% of prescriptions
2. Prescribing error rate in GP surgeries 5% of all prescriptions
3. Dispensing error rates in hospitals 0.02- 2.7% of dispensed medicines
4. Dispensing error rates in Comm Pharmacies 0.01 – 3.32% of dispensed medicines
5. Medicines administration errors in hospitals 3-8%

5)      Londonwide Prescribing: errors rate in general practice

5% of 187 million prescriptions of which 0.18% were severe errors

With a billion prescription items prescribed in primary care in the NHS in England annually

This research predicts 1.8 million serious prescribing errors each year

• 31,167 Rx errors detected per day
• 16.7 Rx errors detected per day per pharmacy

•           

6)      Londonwide Prescribing: severe errors rate in general practice

5% of 187 million prescriptions of which 0.18% were severe errors

• 56 SEVERE errors detected per day
• 0.03 SEVERE errors per day per pharmacy

7)      Cost to the NHS

1. A study was conducted in two large hospitals in Merseyside to determine the current burden of ADRs in the NHS. The study found that of 18,820 patients aged over 16 years admitted to hospital over a six-month period, there were 1,225 admissions judged to be related to an ADR, giving a prevalence of 6.5%. Of these 1,225, the ADR was judged to have led directly to the admission in 80% of cases. The majority (72%) of ADR-related admissions were judged as avoidable, including medication errors. The median bed stay was eight days, accounting for 4% of the hospital bed capacity. The projected annual cost of such admissions to the NHS was £466 million.
2. In a review of medication error incidents reported to the NRLS over six years between 2005 to 2010 there were 525,186 incidents reported. Of these, 86,821 (16%) of medication incidents reported actual patient harm, 822 (0.9%) resulted in death or severe harm.
3. This means that in London 1 patient dies or has severe harm every day as a result of medication incident.
4. This means a jumbo-jet load of Londoners are seriously harmed or die as a result of the NHS intervention where care and recovery was expected from an illness.

8)      There is a need to improve safety, effectiveness of intervention and patient experience.

9)      The end result should be reduction

1. in harm caused by prescribed medicines,
2. in waste of NHs resources,
3. in hospital reductions

10)  The most vulnerable, the elderly, form the largest group of people harmed by taking prescribed medicines.

11)  Iatrogenic diseases and the elderly

1. One study concluded, ‘Iatrogenic disease in the elderly population has a particularly significant impact due to the conjugation of major demographic phenomena. Multiple drugs, multiple physicians, multiple chronic diseases, hospitalisation, and disease arising from medical or surgical procedures increase the risk of iatrogenic disease in the elderly. Iatrogenic disease may have a significant psychomotor impact and devastating social consequences. Interventions that can prevent iatrogenic complications include a geriatric interdisciplinary team, pharmacist consultation, acute care for the elderly units, and advance directives.’

12)  Iatrogenic Diseases as a Reason for Admission to the Intensive Care Unit (ICU)

1. Another study concluded, ‘Iatrogenic diseases are a persistent and important reason for admission to the ICU, and the risk factors, causes, and consequences remain unchanged since 1980. Despite 25 years of experience with high-technology medicine, ID still has a negative impact on the health and resources of society.’

The third WHO Global Patient Safety Challenge: Medication Without Harm is worth further consideration as prevention of harm as a result of taking prescribed medicines remains a growing problem in the UK and affects the elderly and the mentally ill patients in particular. I hope the Health and Social Care Committee will call for and consider evidence on the incidence and prevention of medicines induced iatrogenic diseases.

Feb 2023