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6 news The key role of the hospital pharmacist in medication safety was highlighted at the inaugural conference of the Irish Medication Safety network (IMSn) which took place in Farmleigh House in Dublin last month. Entitled ‘networking for Safety’, the conference, which sought to improve standards in medication safety, was officially opened by the Minister for Health Ms Mary Harney and was attended by a number of pharmacists and other healthcare professionals. Speakers included Dr Deirdre Madden, author of the Patient Safety Commission’s 2008 publication ‘Building a Culture of Patient Safety’; Ms Marita Kinsella, Chief Pharmacist at the Department of Health; and senior Hospital pharmacist and winner of the 2009 Helix Health Pharmacist of the year Award, Mr Tim Delaney has been seconded to the HSE from Tallaght Hospital as national Programme lead of the Executive’s new national Medication Safety Programme. The HSE’s new medication safety programme was established by the Executive within its Quality, Safety and Risk Framework and forms part of the HSE’s Quality and Clinical Care Directorate under Dr Barry White. Initial projects currently being developed by the new programme include: a standard drug prescription and administration record The Irish Medicines Board (IMB) has recently signed three separate co-operation arrangements with its counterpart regulatory bodies in Canada, new Zealand and Singapore. The arrangements, which will facilitate enhanced regulatory performance and public safety, are designed to broaden existing contacts and to establish a co-operative framework of mutual support and information exchange. The three new arrangements were signed by Mr Pat O’Mahony, Chief Executive of the IMB, at the hospital pharmacists with a special interest in medication safety. The IMSn’s principal aim is to improve patient safety with regard to the use of medicines through improved sharing of information throughout the acute healthcare sector and the adoption of national and global initiatives to help minimise risks to patients. A key aim of the IMSn is to have medication safety included in HIQA’s new hospital licensing regime which is currently going through the consultation process. Speaking at the conference, Minister for Health Ms Mary Harney said : “I am pleased to see the Irish Medication Safety network working hard to raise the standards of medication safety in for acute hospitals; a national medication management standard for acute hospitals and self – assessment system; and the implementation of the Irish Medication Safety network’s guidance 5th international Summit of Heads of Medicines Regulatory Agencies, which took place last month in the UK. According to Mr O’Mahony, “Increased communication and cooperation between the IMB and our counterparts in Canada, new Zealand and Singapore will assist each organisation to better achieve our common goal of protecting and enhancing the health and safety of our respective populations.” Co-operation arrangements were signed by the IMB with: Health Canada represented our hospitals, and I thank them for their commitment and dedication in this area. I’d like to acknowledge their work in highlighting the importance of implementing best practice in medication safety standards throughout our acute healthcare system.” Established in 2007, the IMSn is a voluntary network of independent pharmacists and other specialists working in the acute healthcare sector with a special interest in medication safety. The network has representation from all major hospitals in the country, both public and private, reaching over 50 acute healthcare facilities in Ireland. For more information please see www.imsn.ie documents on specific highrisk medications and the monitoring of compliance by individual hospitals. As national lead with the medication safety programme Mr Delaney will also be the HSE representative on the Medication Safety Forum, which was set up by the Department of Health in response to the report of the Commission on Patient Safety and Quality Assurance. Chaired by the Chief Pharmacist at the Department of Health Ms Marita Kinsella, the Forum is monitoring 29 separate improvement projects designed to achieve safer, more effective use of medicines. by Ms Meena Ballantyne, Assistant Deputy Minister, Health Products and Food Branch; new Zealand Medicines and Medical Device Safety Authority (Medsafe) represented by Dr Stewart Jessamine, Group Manager; and the Health Sciences Authority of Singapore represented by Dr John lim, Chief Executive Officer. Similar arrangements are already in place between the IMB and its American counterpart, the US FDA, the UK regulator, the MHRA, and Australia’s Therapeutic Goods Administration (TGA). The majority of medication errors in Irish residential care facilities are “entirely preventable” a new study has revealed. According to the research which involved a three year prospective study of medication errors in residential settings as reported to the national Poisons Information Centre (nPIC) of Ireland, almost half of all errors or 43.1 per cent involved the administration of the wrong medication while 45.1 per cent related to patients being given the wrong dose. The study, which was carried out by researchers from the nPIC and the Department of Geriatric Medicine at Beaumont Hospital in Dublin, reviewed a total of 102 cases where residential care patients experienced a medication error between January 2007 and December 2009. Medication errors were categorised as: administration errors, prescribing/ physician errors or dispensing/ pharmacy errors. While the study found that errors involving the administration of the wrong medication and the wrong dose predominated, there were two pharmacy errors involving the dispensing of the wrong medication. According to the research the principle medicines implicated in medication errors in patients over the age of 65 were cardiac drugs at 15.2 per cent and gastrointestinal preparations at 13.6 per cent, while anti-epileptics accounted for 11.9 per cent of errors. Anti-epileptic medication was implicated in the vast majority of medication errors in the under issue 10 volume 12 • novemBeR 2010 Hospital pharmacists have key role in medication safety Tim Delaney seconded to the Hse’s medication safety programme Mr Tim Delany IMB signs co-operation arrangements with counterparts in Canada, new Zealand and Singapore Minister for Health, Mary Harney and geraldine Creaton, irish Medication safety network (iMsn) at the inaugural iMsn conference in Dublin. Majority of medication errors in irish residential care facilities “entirely preventable” 65s at 36.1 per cent, followed by anti-psychotics at 13.3 per cent and antidepressants at 12. 4 per cent. According to the study 12 patients were symptomatic at the time of the nPIC enquiry. A total of 11 patients were referred to a hospital emergency department, 18 were referred to a GP, while supportive management was recommended for 38 patients. “Cardiac and anti-epileptic medications predominated in patients aged over 65 and under 65 respectively. The majority of errors involved the administration of the wrong medication and the wrong dose. These errors are entirely preventable,” the study concluded. Meanwhile another new study by the same research team entitled ‘Medication errors in older adults: The Experience of the nPIC Ireland’ has revealed that the vast majority of medication errors among the elderly were the result of individuals inadvertently taking an additional dose of their medication(s). While the study found that most incidents took place at home and did not result in any harm, the researchers concluded “healthcare professionals should always discuss correct dosing procedures with older adults.” These research studies were presented by researchers from the nPIC, Ireland at the 6th Congress of the European Union Geriatric Medicine Society, which took place in Dublin from the 29th of September to the 1 st of October last.
INTRODUCE YOUR CUSTOMERS TO A BRIGHT NEW WAY TO QUIT NEW Nicorette ® Icy White Gum NEW Name of the Medicinal Product: Nicorette Icy White 2mg and 4mg Medicated Chewing Gum. Qualitative and Quantitative Composition: Each medicated chewing gum contains 2 mg or 4mg nicotine as a resin complex. Pharmaceutical Form: 2mg Gum: Medicated Chewing Gum. A square, coated, white coloured chewing gum. 4mg Gum: Medicated Chewing Gum. A square, coated, cream coloured chewing gum. Therapeutic Indications: For the treatment of tobacco dependence by relieving nicotine craving and withdrawal symptoms: thereby facilitating smoking cessation in smokers motivated to quit. - helping smokers temporarily abstain from smoking. Posology and Method of Administration: Nicorette Icy White Gum should be chewed slowly. Smoking cessation Adults The strength of gum to be used will depend on the smoking habit of the individual. In general, if the patient smokes fewer than 20 cigarettes a day, Nicorette Icy White 2mg Gum is indicated. If more than 20 cigarettes per day are smoked Nicorette Icy White 4mg Gum will be needed to meet the withdrawal of the high serum nicotine levels from heavy smoking. The patient should be urged to stop smoking completely when initiating therapy with Nicorette Icy White Gum. The chewing gum should be used whenever there is an urge to smoke according to the “chew and rest” technique described on the pack. After about 30 minutes of such use, the gum will be exhausted. Not more that 15 pieces of the chewing gum may be used each day. Absorption of nicotine is through the buccal mucosa, any nicotine which is swallowed being destroyed by the liver. Nicorette Icy White Gum may be used for up to 3 months during which time the habits associated with smoking will be lost. For those using the 4mg Gum, the 2mg will be helpful during withdrawal. If not successful after 12 weeks the patient should be encouraged to make a fresh attempt to stop smoking. This may necessitate full or partial re-treatment with an NRT programme. Temporary Abstinence During periods of temporary abstinence, the patient should use Nicorette Icy White Gum when required to relieve nicotine cravings and withdrawal symptoms. The strength of gum to be used will depend on the smoking habits of the individual. In general, if the patient smokes fewer than 20 cigarettes a day, Nicorette Icy White 2mg Gum is indicated. If more that 20 per day are smoked Nicorette Icy White 4mg Gum is indicated. Not more than 15 pieces of the gum should be used per day. A minor reduction in total clearance of nicotine has been demonstrated in healthy elderly patients, however, not justifying adjustment of dosage. Contraindications: Use in non-smokers and use in persons hypersensitive to nicotine or any ingredient in Nicorette Icy White Gum. Special Warnings and Precautions for use: Nicotine in any dose form is capable of inducing a dependence syndrome after chronic use and is highly toxic after acute use. However, dependence with Nicorette Icy White Gum is a rare side-effect and is both less harmful and easier to break than smoking dependence. Nicorette should be used with caution in patients with cardiovascular disease, severe/moderate hepatic impairment, severe renal impairment, active and duodenal ulcers. Nicotine, both from NRT and smoking, causes the release of catecholamines from the adrenal medulla. Therefore, Nicorette should be used with caution in patients with hyperthyroidism or pheochromocytoma. Patients with diabetes mellitus may require lower doses of insulin as a result of smoking cessation. Smokers who wear dentures may experience difficulties in chewing Nicorette Icy White Gum. Interactions with other medicinal products and other forms of interaction: Smoking (but not nicotine) is associated with an increase in CYP1A2 activity. After cessation of smoking, reduced clearance of substrates for this enzyme may occur. This may lead to an increase in plasma levels for some medicinal products of potential clinical importance and for products with a narrow therapeutic window, e.g. theophylline, tacrine and clozapine. The plasma concentration of other drugs metabolised in part by CYP1A2 e.g. imipramine, olanzapin, clonipramine and fluvoxamine may also increase on cessation of smoking, although data to support this are lacking and the possible clinical significance of this effect is unknown. Limited data indicate the metabolism of flecainide and pentazocine may also be induced by smoking. Undesirable Effects: Nicorette Icy White Gum may cause adverse reactions similar to those associated with nicotine administered by other means and are dose dependent. Common (>1/100) CNS: Headache Gastrointestinal: Nausea, GI discomfort, vomiting, hiccups. Local:Irritation of the mouth or throat, jaw muscle ache. Less common (1/100-1/1000) Circulation: Palpitations. Skin: Erythema, urticaria. Rare (
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