The document discusses medication safety and outlines several key points: 1) The goal of the Iraqi Ministry of Health is to provide safe and effective medications to all patients through multidisciplinary teams including physicians, pharmacists, nurses and patients. 2) Medication safety involves appropriate prescribing, thorough risk-benefit analysis, and monitoring for adverse drug events, especially with polypharmacy which increases with age and multiple chronic conditions. 3) Education, training, protocols, supervision and communication are important strategies to reduce medication errors and ensure safe and effective use of medications.

1. Medication Safety
Laith Alasadi

2. Our goal
• The motto of the Iraqi Ministry of Health is to
provide a safe and effective medicines for all
patients.
• To implement this mission, all health
practitioner must work in a multidisciplinary
team including physicians, pharmacist, nurses
and the patient to achieve the desired goal.

3. Medicines
• Medicines are chemical compound used to
treat diseases, manage conditions, diagnosis,
prophylaxis and relieve symptoms.
• Medicines are generally safe when used as
prescribed or as directed on the label, but
there are risks in taking any medicine.

4. Medicine and biological system
• All medicines exert effects on the biological
system and also affected by its.
• The two terms pharmacokinetics and
pharmacodynamics explain the previous
sentence.

5. Medication safety
• Medication safety should start with appropriate
prescribing and a thorough risk–benefit analysis
of each medicine is often the first step.
• For example:
prophylactic aspirin and NSAID without a gastro
protective-agent left the patient at an increased risk
of gastrointestinal bleeding.
Therefor the decision to prescribing NSAID to
patient suffer from arthritis and has duodenal ulcer
must be judged by what called risk benefit balance
with continuous monitoring.

6. Polypharmacy
• Polypharmacy term refers to patient take
multiple drugs for different diseases or
symptoms.
• Polypharmacy can put the patient at risk of
adverse drug events and drug interactions
when not used appropriately.

7. Polypharmacy
• Polypharmacy has increased dramatically with
greater life expectancy and as older people
live with several chronic diseases.
• Polypharmacy increases the likelihood of side
effects, as well as the risk of interactions
between medications, and may make
adherence more difficult

8. Medication management pathway
• Medication management involves
- Prescribing
- Dispensing
- Administering
- Monitoring.
• Medication management is complex and
involves several different clinicians.

9. Poor prescribing
• Poor prescribing has been described to take three forms
• Overprescribing: occurs when a medication is prescribed
whose risk of harm exceeds its likely benefit in a particular
individual.
• Under prescribing: occurs when a medication is not
prescribed whose likely benefit is less its therapeutic effects
• Misprescribing: occurs when either the wrong medication is
prescribed or the wrong dose, route, frequency or duration of
administration is chosen.

10. medication review
• Ensure that medication reviews are conducted or
supervised by a clinician with the appropriate
skills and expertise, acting as part of a
multidisciplinary team
• medication review is considered an inherent role
of a pharmacist, medicines should also be
reviewed by clinicians whenever decisions are
being made about prescribing, dispensing and
administering medicines.

11. Policies and Guidelines
• Ensure that policies, procedures and
guidelines for clinical handover include:
communicating issues relating to a patient’s
medication management during their episode of
care, and the roles, responsibilities and
accountabilities of clinicians.

12. Policies and Guidelines
• Ensure that the content of medicine-related
information and decision support tools is:
Current, and consistent with evidence-based
prescribing, dispensing, compounding and
administration of medicines
• Consistent with the organization's policies,
procedures and guidelines available in several
formats
• Integrated within the organization's digital or
electronic systems.

13. Policies and Guidelines
• Dosing calculators and medicine-interaction
databases
• Reference texts, and telephone-based medicines
information and advice services
• Guidelines for safe administration of specific
medicines (for example, administering medicines
via enteral tubes)
• Selection of treatment in specific clinical
situations (for example, appropriate choice of
antimicrobial).

14. Policies and Guidelines
• Audits of temperature control of storage
facilities, including room temperature,
refrigeration and frozen storage
• Regular testing and maintenance schedules for
temperature alarms and temperature recording
devices
• Transportation or transfer of temperature-
sensitive medicines between storage areas or
facilities
• Workforce orientation and training on cold chain
management

15. Policies and Guidelines
• Implement policies, procedures and guidelines
for disposal of unused, unwanted or expired
medicines
• Review and implement work practices and
distribution systems that minimize wastage of
medicines, such as by regular checking of
stock expiry dates and stock rotation.

16. • Set up inventory management practices to eliminate
wastage of medicines. Take a proactive and planned
approach to changes to formulary listing, and conduct
routine reviews of medicines use.
• Review and implement work practices (for example,
compounding of high-risk medicines such as multiple doses
of cytotoxic chemotherapy) that minimize waste, ensure
safe handling and promote the efficient use of medicines.

17. Policies and Guidelines
• Review organizational policies, procedures and
protocols for disposal of unused, unwanted or
expired medicines to ensure:
• Minimal risk to the workforce and the
environment (for example, cytotoxic
chemotherapy, vaccines, hazardous substances)
• Assignment of responsibility and accountability
• Consideration of situations when only part of a
tablet, capsule, ampoule or infusion is required

18. Strategies to reduce the opportunity
for error
• To ensure safe and effective use of medicines
within the health service organization, identify
opportunities for patient harm and implement
strategies to prevent medicine-related errors.
• Steps taken early in the medication management
pathway can prevent adverse events occurring
later in the pathway.

19. Education
• The importance of safe medication practice should be
conveyed at an early stage in training of health care
professionals, and embedded in training curricula.
• The curricula should be made aware of the importance
of establishing an accurate medication history, covering
both prescribed (conventional and/or traditional and
complementary medicines) and non-prescribed
medications (including self-prescribed, over-the-
counter, food supplements, and traditional and
complementary medicines).
• Similarly, a history of allergy to any previous
medication should be elicited.

20. Education
The education must focused five elements
• Starting a medication
• Taking medication
• Adding a medication
• Reviewing medication
• Stopping medication.

21. Education
• Application of the these element for Medication
Safety tool may vary depending on the country or
local context and specific setting.
• It may be applied in targeted population groups
(for example, older people, children, pregnant
and breastfeeding women)
• Caregivers also have an important role and can
make similar errors to those made by
professionals

22. Communication skills
• Good communication is vital, including a
formal comparison of medicines pre and post-
care, so-called medication reconciliation.
• Good communication lead to high adherence
rate with correct manner of medication
administration, also result on low chance of
medication errors.

23. Training
• All health care professional must be well
trained on up to date guidelines and
therapeutics protocols.
• The training also include good documentation
practice in all management steps.
• Health care professional must engaged in
problem solving practice and follow CABA
pathway ( corrective action and preventive
action)

24. Protocols
• In the health care organization, there must be
agreed guidelines and protocols.
• Following these guidelines and protocols will
be minimized medication errors.
• The protocols should be updated frequently
with evidence based studies.

25. Close supervision
• The system of health care organization should
not permit the trainee and new employment
to work on their owns.
• Training is the best approach to ensure
minimum errors and enhance clinician skills
and knowledge.
• The supervisors focusing on learning the
trainee and not give the authority to work
autonomously at early stages.

26. Thank you