Using our advice
This article is aimed at healthcare professionals (HCPs) who have a role in improving medication safety. The term ‘patients’ in this article extends to carers, families and the public, including different communities.
Why a patient-centred approach is needed
Using medicines is an inherently risky process, with potential for harm at all stages. It’s everyone’s responsibility to ensure medicines are used safely. However, patients are the only people present for their entire healthcare journey. Others, such as HCPs, are only there for part of it. This is important to remember, especially when we consider high-risk situations like transitions in care.
It is essential HCPs recognise and understand the knowledge and expertise patients develop through managing their health conditions. It is also important that the voice of those with lived experience is heard and is central to any system-wide development and improvement work.
Patients should be involved at every level of medication safety and be supported to take ownership of their safety and care where appropriate. This includes shared decision-making, policy development, quality improvement and bringing the voice of patients to the forefront of healthcare.
The safe use of medicines may be impacted by healthcare inequalities. Individuals with certain characteristics may have a greater risk of harm; these are termed medication safety inequalities. It is crucial not to exclude specific groups of patients, to avoid exacerbating medication safety inequalities. More information can be found in Addressing medication safety inequalities across the system (SPS page).
The value of bringing the patient voice into medication safety
Specialist Pharmacy Service’s (SPS) experience of delivering the Safer use of time critical medicines programme (SPS page), highlights how critical patient involvement is for improving medication safety. Some of these insights are discussed below.
Improved understanding of diverse perspectives
Patients are the only ones who experience the whole healthcare journey. Therefore they are best placed to help others understand their experience. Including and understanding people’s diverse views and perspectives can help organisations:
- identify problems, including how and where they are occurring
- create novel change ideas
- visualise the potential impact improvements can have on patient care
- evaluate changes in a more meaningful way
Without this perspective, HCPs may make incorrect assumptions which can lead to ineffective and potentially unsafe changes.
Promotes engagement
Including the patient perspective brings the human element to the forefront, reminding people why improvements are needed and helping to promote wiser resource investment. It also may encourage others to get involved, if they see people like them already engaged. It is important patients are involved in design and delivery from the start and throughout the process.
Provides inspiration to change and maintains momentum
Patient involvement can be a strong catalyst for starting or maintaining momentum of a medication safety project. Fluctuations in momentum are a natural part of any work but reminding people why you’re doing the work can improve motivation.
Improved accountability
Involving patients helps to ensure accountability for decisions made and actions undertaken, as they represent those who will be directly affected by the outcome. It also helps HCPs understand the consequences of unsolved problems.
How to improve patient involvement in medication safety
Involving patients in medication safety does not need to be complicated. Start simply. Asking patients how they’d like to be involved and acting on this is a good starting point.
Every time a HCP talks with a patient about their medicines, it is an opportunity to discuss medication safety. Shared decision making provides the foundation for patients to better understand their medicines and the choices surrounding them. Talking about medication safety can lead to the identification of problems and potential solutions, before harm occurs.
Quality improvement (QI) is one way to improve medication safety. NHS England describes QI as a systematic approach to solving an issue. Those closest to the issue are involved in understanding it deeply, developing ideas, testing ideas using rapid cycles of change and utilising data to learn and adapt. This cannot be done effectively without involving patients.
Some things need to happen at an organisational level, such as introducing Patient Safety Partners to the organisation and creating a culture of always involving patients in medication safety. However, there are many things HCPs can do. Some of these are described below.
Co-production
Co-production is an effective approach to working with patients, particularly from diverse communities, to design and improve a service for better outcomes of care. However, this should be proportionate and consider organisational capacity and capability of engaged and willing people.
NHS England guidance on co-production provides a useful summary. It includes The World of Co-production and QI video, discussing common pitfalls and benefits of this approach.
Patient Safety Partner involvement
Patient Safety Partners (PSPs) work within healthcare organisations, helping to improve patient safety and contribute patient perspectives into safety and governance agendas. Involve your PSPs in project teams and committees, inviting them to seek clarity and challenge ideas where needed. Ensure PSPs are part of the planning and design stages of workstreams. Patient Safety Specialists in your organisation will be able to support you in contacting your PSPs if needed.
Share patient stories
Hearing from patients about their experiences can improve motivation and engagement. It helps others to understand the problems faced and can encourage new change ideas.
Stories can be shared in person or via a range of media. Useful examples of patient experience videos can be found in Parkinson’s UK’s time critical medication patient stories.
Incident investigations
The Patient Safety Incident Response Framework (PSIRF) emphasises greater engagement with those affected by an incident, including patients. This enables greater learning from incident investigations. NHS England provides guidance on engaging and involving patients, families and staff following a patient safety incident.
The Health Services Safety Investigations Body (HSSIB) Knowledge Exchange provides information to help people involved in patient safety investigations.
Work with expert colleagues
Find your Patient Experience and Involvement Lead (or similar role) within your organisation and work with them to find better ways to ensure the patient voice is central to your work. They will be able to provide useful advice and techniques on how to best involve patients with a variety of needs and abilities and understand their experience.
Reach out to existing networks
Find your local patient groups, networks and communities and reach out to them. Tell them about the work you’re doing and invite them to get involved, where appropriate.
Telling people what you’re doing and encouraging open discussion around the issue, can help start conversations and spark ideas. Posters, screensavers, leaflets and other formats can help communicate the story to a wider audience.
Focus groups
When you have a particular problem to solve or question to answer, focus groups can provide time to look at this in detail. Inviting patients to focus groups ensures their perspectives and ideas are included.
Surveys
Surveys are a relatively easy and inexpensive way to understand a problem and potential solutions. Resource is required to create the questionnaire, distribute it, obtain responses and analyse the data.
Associated resources
The SPS website contains various examples of patient involvement in medication safety, from patient stories to practical advice on collaborating with patient representatives.
You’ll find stories of patient experience, told through videos and podcasts, in the following SPS resources:
- Improving the safe use of time critical medicines (SPS page)
- MSATS – Safe use of valproate (SPS page)
- Developing direct oral anticoagulant safety across a system (SPS page)
- Developing insulin safety across a system (SPS page)
- Developing opioid safety across a system (SPS page)
- Managing complexities of medication use across care boundaries (SPS page)
- Addressing medication safety inequalities across the system (SPS page)
- Embedding medication safety improvement within an organisation (SPS page)
SPS articles providing advice on involving patients in medication safety:
- Collaboration opportunities to improve medication safety (SPS page)
- Learning from medication safety events (SPS page)
Supporting guidance
Many resources exist to support better patient involvement in medication safety and the NHS. Examples of some of these resources are included below.