My name is <______________> and I’m here from <___________________> to talk to you about medication safety. (Be sure to fill our your name in the slide). Today we’ll be talking about preventable adverse drug events, with a focus on drug-drug interactions. If you don’t know what an adverse drug reaction is, don’t worry- we’ll cover that in the next couple of slides. EXAMPLE PRESENTER

ISMP Canada is an independent not-for-profit dedicated to reducing preventable harm from medications. This presentation was created based on data and research ISMP Canada has collected on medication harm.

The Manitoba Institute for Patient Safety (MIPS) is an organization that supports organizations, healthcare providers, and patients to have safer interactions. This presentation was made possible in part by the Manitoba Institute for Patient Safety through funds from the Dr. John Wade Patient Safety Grant.

Simply put, an ADR is “any harmful, unintended, or undesired effect of a drug that occurs when the drug is used by a patient”. This can include allergies, side effects, or drug interactions

Remember how we said that in older patients, ADRs are more common in the elderly population due to natural changes in the body? Here are three of the ways that changes in the body can alter a drug’s intended effects: 1) As we get older, our body fat % increases, while our body water % decreases This changes how long some drugs stay in our body – some may have prolonged effects, some may have shortened effects 2) Naturally as we age, so do our organs- more specifically, human kidneys lose a percentage of their function with every passing decade When our kidneys get older, they start to filter out less and less waste from our bodies This also means that less drug is filtered out to be excreted as urine- and the drug is able to stay in the body for longer 3) As we get older, the rate at which blood is filtered through the liver is decreased as well The liver is largely responsible for metabolising (or breaking down) drugs and various other substances found in the blood Therefore, if less blood makes it to the liver, that means less drug is being broken down – often prolonging the drug’s effects

This can happen when one drug cancels out another drug’s effects 2. This can occur when two drugs have similar effects 3. New side effects that weren’t present before can occur when two drugs don’t get along with each other 4. …and in the worst case scenario, a drug interaction can be fatal

There are several types of drug interactions, but today we will focus on Drug-Drug Interactions Drug-drug interactions: When 2 drugs interact with each other

Other various factors that can cause an increased risk in DDIs include The fact that many elderly patients are already experiencing multiple ongoing diseases 2) These ongoing diseases often get worse and worse as time goes on 3) Polypharmacy – which is basically a fancy word to describe the buffet-sized quantity of pills that many seniors have to consume on a daily basis The more medications you take, the higher the risk that two of them will interact with each other!

Your pharmacist can do much more than count pills and ring you out at the pharmacy! Drug-Drug interactions are preventable! If you’re ever unsure about a drug interaction or a new medication, pharmacists will be more than happy to help look into it for you.

A large number of DDIs involve antibiotics Antibiotics treat common infections such as Urinary Tract Infections (UTIs) Group A Streptococcus Pharyngitis (Strep Throat) Community Acquired Pneumonia DDIs involving antibiotics can often be resolved by using a different type of antibiotic Pharmacists are medication experts who are ready to help   It’s important that patients know a little bit about some of the more common medications that can cause drug-drug interactions and antibiotics are some of the most commonly prescribed medications that can cause DDIs. A large number of Drug-Drug Interactions we know about involve antibiotics. Urinary tract infections, Strep throat, and community acquired pneumonia are some the more common infections that are treated by antibiotics. The good news is that there are many types of antibiotics that can be used to treat many different types of infections. This means if there is a potential drug-drug interaction between a medication you are taking and an antibiotic you are prescribed – a healthcare provider can simply choose another antibiotic that won’t interact with the medication you are already taking. The even better news is that your pharmacist is a medication expert who can help you figure out what will work best for you in collaboration with other healthcare providers.

Ask your pharmacist questions about your medications Report all medications you are taking to unfamiliar doctors, nurses, or pharmacists; Ask your pharmacist to help you with a comprehensive medication review; Carry a list of your medications to share with your health care providers; Request a double check on drug interactions when you are taking a new medication, including antibiotics; and Ask your pharmacist questions about your medications There are several things you can do to prevent drug-drug interactions and we’ll cover them in detail over the next several slides Report all medications you are taking to unfamiliar doctors, nurses, or pharmacists; Ask your pharmacist to help you with a comprehensive medication review; Carry a list of your medications to share with your health care providers; Request a double check on drug interactions when you are taking a new medication, including antibiotics; and Ask your pharmacist questions about your medications Pharmacies can be busy with high workloads. This can unintentionally lead to a missed interactions

Comprehensive medication reviews are an opportunity to discuss your medical conditions and medications with your pharmacist. A pharmacist can help you: Prepare a complete list of your medications to carry with you at all times Review your medications to make sure you aren’t taking Potentially Inappropriate Medications One of the most effective ways to prevent a lot of what was mentioned is to participate in a comprehensive medication review. It provides a focused opportunity to discuss your medical conditions and medications with your pharmacist. You may then leave the review with a complete list of your medications to carry with you at all times, that is accurate and up-to-date This review can also allow the pharmacist to brief your medications to make sure you aren’t taking Potentially Inappropriate Medications and to work collaboratively with your doctor to make adjustment if some are identified

https://www.youtube.com/watch?v=f2KCWMnXSt8 The Video we are about the watch is called One Simple Solution for Medication Safety and it was produced by an organization called Reframe Health Lab. It outlines how to create a medication list. The image is hyperlinked. (Hint: It may work better to open the video in a separate window before you begin your presentation)

It’s Safe to Ask is a simple-to-use resource that can help you better understand the medications you are taking. This slide contains MIPS version of the 5 Questions to Ask. It is a good idea to introduce this tool to senior population during presentation. (Hint: This document, and the MIPS It’s Safe to Ask Medication Cards, make good handouts to accompany your presentation: http://mbips.ca/hp-it-s-safe-to-ask-medication-card.html) Visit Manitoba Institute for Patient Safety for information on 5 questions to ask your healthcare provider at: http://mbips.ca/hp-it-s-safe-to-ask-medication-card.html

With age, we develop more health conditions, and thus we take more medications. Body changes associated with aging can increase the risk of medication harm. The majority of drug-drug interactions occur when antibiotics are prescribed Consider participating in a Comprehensive Medication Review and carry an up-to-date medication list with you It’s Safe to Ask – 5 Questions to Ask About Your Medications empowers you be proactive about medication safety In conclusion… (read slide)

Any questions?

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