Taking time to talk and listen to patients to help prevent medication harm – such as the medicine ‘triple whammy’ putting thousands of Kiwis at risk of kidney damage – is the focus of Patient Safety Week.

Encouraging conversations between health professionals and health consumers about their medications was chosen by the Health Quality & Safety Commission as the focus for this year’s Patient Safety Week. The aim is to try and prevent the harm caused by patients taking the wrong medicines, the wrong combination of medicines, the wrong dose and other medication safety issues.

In particular, the Commission is highlighting the ‘triple whammy’ – the potentially dangerous combination of taking the wrong off-the-shelf or prescribed pain killers when already taking heart pills and diuretics – that can lead to serious kidney damage. New data shows that about 22,000 older New Zealanders are being prescribed the combination of the three medicines each year.

Commission medication safety clinical lead Dr Alan Davis says the ‘triple whammy’ risk often arises when people who are taking heart failure or blood pressure medicines plus diuretics (water tablets) then start on a non-steroidal anti-inflammatory (NSAID) to treat pain or swelling.

Some NSAIDs – like ibuprofen and diclofenac (voltaren) – are available to buy from pharmacies and supermarkets as well as by prescription. Used together, the combination of heart/blood pressure medication (i.e. ACE inhibitors / angiotensin receptor blockers), diuretics and NSAIDs can cause significant harm.

Dr Davis said the triple whammy combination was involved in more than half of reported cases of treatment-related acute kidney failure.

Data released by the Commission’s Atlas of Healthcare Variation this week shows that in 2016 about 22,000 New Zealanders aged over 65 were dispensed the ‘triple whammy’ of these medicines in the same quarter. It does not include the people who bought an NSAID over-the-counter or were prescribed NSAIDs on an earlier occasion.

New Zealand’s Centre for Adverse Reaction Monitoring (CARM) received 119 reports of kidney adverse reactions from January 2000 to December 2012 that were associated with the use of pain relief or anti-inflammatory medicines. These included four deaths and 12 cases that were considered life-threatening. Most of the reports were in adults over 50 years of age.

Davis said health professionals are advised not to supply the combination of the three medicines to people with risk factors for kidney failure – such as older adults, people with some kidney failure already, people at risk of dehydration (vomiting, diarrhoea, inadequate fluid intake), and hypotensive patients.

“Heart and blood pressure medication and pain relief medication affect blood flow in the kidneys, while diuretics can cause dehydration, which can also affect kidney function,” said Davis. So it was important that patients taking heart/blood pressure medicines and diuretics were told not to take over-the-counter NSAIDs and that health professionals checked what medication patients were already taking before prescribing or dispensing NSAIDs for pain relief.

Between 2011 and 2016, ACC accepted over 5,800 treatment injury claims related to medication errors and reactions. ACC’s chief clinical advisor Peter Robinson said while many of these injuries were minor, a small number were severe, with long-term effects on patients, and were a priority for ACC to prevent.

During Patient Safety Week (Nov 5-11) health professionals are being encouraged to consider:

  • the importance of giving consumers time – their questions are valid
  • what is common for you may be unusual, confusing and challenging for consumers
  • knowledge is power – the more a consumer knows, the less likely they are to make a mistake with their medicines
  • cost could be a barrier to consumers filling prescriptions and continuing to take medication – talk to them about this
  • practising the three steps to better health literacy: find out what people know, build health literacy skills and knowledge, and check you were clear.

Consumers are being encouraged to ask clinicians questions about their medication including:

  • What is my medicine called?
  • What is it for?
  • When and how do I take it?

Patient Safety Week resources are available here

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