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The author reflects on the development and implementation of national in-patient prescription chart in Wales. The author mentions that a single harmonized standard in-patient medication administration chart was set up by the All Wales Medicines Strategy Group (AWMSG) in Wales in 2002. He states that the standards for the design identified by the Academy of Medical Royal Colleges were applicable to electronic and paper charts.

Aims: To review the medicines optimisation activities of the All Wales Medicines Strategy Group (AWMSG), a committee established in 2002 to advise the Welsh Government on "all matters related to prescribing". Although AWMSG conducts other activities (e.g., health technology appraisal for medicines), we focus here on its role in advising on medicines optimisation., Methods: Prescribing indicators have been used in Wales to measure change, together with data on volumes and costs of medicines dispensed. A range of improvement strategies have been categorised under the "four Es", namely educational initiatives, economic incentives, "engineering" and "enforcement"., Results: AWMSG has helped health professionals in NHS Wales to reduce harm and waste, and to reduce inappropriate local or regional duplication and variation. Specific initiatives include the achievement of major cost savings by supporting increased generic prescribing and an "invest to save" approach related to prescribing of hypnotics and tranquillisers, non-steroidal anti-inflammatory drugs (NSAIDs) and proton pump inhibitors. AWMSG also successfully commissioned the introduction of a single national in-patient medication chart for Wales in 2004. Ongoing priorities include a focus on reducing prescribing of certain medicines deemed "low value for prescribing" and on optimising the use of biosimilar medicines., Conclusions: Since 2002, AWMSG has acted as a national medicines optimisation committee in Wales. From the outset, pharmacists and clinical pharmacologists have collaborated closely and shared their complementary expertise to make a much greater contribution to the safe, effective and cost-effective use of medicines than either group could have achieved by working separately., (© 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)

Aims: This study aimed to assess the impact of a National Reporting Indicator (NRI) on rates of reporting of suspected adverse drug reactions using the Yellow Card scheme following the introduction of the NRI in Wales (UK) in April 2014. Methods: Yellow Card reporting data for general practitioners and other reporting groups in Wales and England for the financial years 2014–15 (study period 1) and 2015–16 (study period 2) were obtained from the Medicines and Healthcare Products Regulatory Agency and compared with those for 2013–14 (pre‐NRI control period). Results: The numbers of Yellow Cards submitted by general practitioners in Wales were 271, 665 and 870 in the control period, study period 1 and study period 2, respectively. This is equivalent to an increase of 145% in study period 1 and 221% in study period 2 compared with the 12‐month control period (2013–14). Corresponding increases in England were 17% and 37%, respectively (P <.001 chi–squared test). The numbers of Yellow Cards submitted by other groups in Wales were 906, 795 and 947 in each of the study periods. Conclusions: Introduction of the NRI corresponded with a significant increase in the number of Yellow Cards submitted by general practitioners in Wales. General practitioner reporting rates continued to increase year on year through to 2018–19 with the NRI still in place. No concomitant change was found in reporting rates by other groups in the health boards in Wales. [ABSTRACT FROM AUTHOR]

Aims: To examine the prevalence of potentially hazardous prescribing in the prison setting using prescribing safety indicators (PSIs) and explore their implementation and use in practice. Methods: PSIs were identified and reviewed by the project team following a literature review and a nominal group discussion. Pharmacists at 2 prison sites deployed the PSIs using search protocols within their electronic health record. Prevalence rates and 95% confidence intervals (CIs) were generated for each indicator. Semi‐structured interviews with 20 prison healthcare staff across England and Wales were conducted to explore the feasibility of deploying and using PSIs in prison settings. Results: Thirteen PSIs were successfully deployed mostly comprising drug–drug interactions (n = 9). Five yielded elevated prevalence rates: use of anticholinergics if aged ≥65 years (Site B: 25.8% [95%CI: 10.4–41.2%]), lack of antipsychotic monitoring for >12 months (Site A: 39.1% [95%CI: 27.1–52.1%]; Site B: 28.6% [95%CI: 17.9–41.4%]), prolonged use of hypnotics (Site B: 46.3% [95%CI: 35.6–57.1%]), antiplatelets prescribed with nonsteroidal anti‐inflammatory drugs without gastrointestinal protection (Site A: 12.5% [95%CI: 0.0–35.4%]; Site B: 16.7% [95%CI: 0.4–64.1%]), and selective serotonin/norepinephrine reuptake inhibitors prescribed with nonsteroidal anti‐inflammatory drugs/antiplatelets without gastrointestinal protection (Site A: 39.6% [95%CI: 31.2–48.4%]; Site B: 33.3% [95%CI: 20.8–47.9%]). Prison healthcare staff supported the use of PSIs and identified key considerations to guide its successful implementation, including staff engagement and PSI 'champions'. To respond to PSI searches, stakeholders suggested contextualised patient support through intraprofessional collaboration. Conclusion: We successfully implemented a suite of PSIs into 2 prisons, identifying those with higher prevalence values as intervention targets. When appropriately resourced and integrated into staff workflow, PSI searches may support prescribing safety in prisons. [ABSTRACT FROM AUTHOR]

We used the HealthWise Wales (HWW) platform to explore public knowledge about the UK Yellow Card scheme (YCS), the spontaneous reporting scheme for suspected adverse drug reactions (ADRs) and whether a short information video could improve awareness. Members of the public in Wales (n = 1606) completed a questionnaire about the YCS, watched the information video and then completed a follow‐up questionnaire. Almost half (46.5%) of respondents said they had previously experienced an ADR (>90% of the ADRs involving prescribed medicines). Before the video, 18% of respondents knew how to report an ADR via the YCS and of these, 34% were from allied‐health professions. Immediately after watching it, 71% participants reported knowing how to report and 82% reported being confident to report. If this awareness were maintained, such an approach could contribute to improved reporting of suspected ADRs by the public. [ABSTRACT FROM AUTHOR]

Advanced Therapy Medicinal Products (ATMPs), which include gene, somatic cell therapies and tissue‐engineered medicines, have the potential to transform current care pathways by offering durable and potentially curative outcomes. However, they are exceptionally expensive, with prices exceeding £1m per patient in some cases. With an expectation that a large number of ATMPs will soon gain marketing authorisation (global market is estimated to reach £9bn to £14bn by 2025), healthcare payers and providers face a number of challenges to facilitate patient access to this new category of medicines. This viewpoint reflects on the experience of introducing ATMPs into the National Health Service in Wales where £1 in every £200 spent on medicines (2019/2020) is expected to be on ATMPs for just 20 patients. Evidence to date makes it apparent that decisions regarding clinical and cost‐effectiveness and the scale of the budget impact of implementing ATMPs create both financial and health service risks. Consequently, there are significant policy implications. A critical examination is made of the approaches taken for the health technology assessment and appraisal of ATMPs, the methods of payment and service impacts of these medicines, and the approach taken to horizon scanning and subsequent modelling of the financial impact over the next 10 years. [ABSTRACT FROM AUTHOR]

A review of all medication incidents reported to the National Reporting and Learning System (NRLS) in England in Wales between 1 January 2005 and 31 December 2010 was undertaken. The 526 186 medication incident reports represented 9.68% of all patient safety incidents. Medication incidents from acute general hospitals (394 951) represented 75% of reports. There were relatively smaller numbers of medication incident reports (44 952) from primary care, representing 8.5% of the total. Of 86 821 (16%) medication incidents reporting actual patient harm, 822 (0.9%) resulted in death or severe harm. The incidents involving medicine administration (263 228; 50%) and prescribing (97 097; 18%) were the process steps with the largest number of reports. Omitted and delayed medicine (82 028; 16%) and wrong dose (80 170; 15%) represented the largest error categories. Thirteen medicines or therapeutic groups accounted for 377 (46%) of the incidents with outcomes of death or severe harm. The National Patient Safety Agency (NPSA) has issued guidance to help minimize incidents with many of these medicines. Many recent incidents could have been prevented if the NPSA guidance had been better implemented. It is recommended that healthcare organizations in all sectors establish an effective infrastructure to oversee and promote safe medication practice, including an annual medication safety report. In the future, preventable harms from medication incidents can be further minimized by; the continued use of the NRLS to identify and prioritize important actions to improve medication safety, a central organization continuing to issue medication safety guidance to the service and better methods to ensure that the National Health Service has implemented this guidance. [ABSTRACT FROM AUTHOR]