Reducing the risk of medication-related deaths in Nigeria

As we clamour for Universal Health Coverage (UHC) and aim towards achieving the United Nation’s Sustainable Development Goals (SDGs) goal3—Ensure healthy lives and promote wellbeing for all at all ages—there is one simple step we could take to help improve the health and wellbeing of Nigerians. We need to bridge the gap of lack of integrated healthcare and patient-centred care using a multidisciplinary team (MDT) approach. We need to put the patient at the centre of care and utilise pharmacist knowledge and input if we must prescribe legally and safely.

The rate of medication-related deaths due to overdose, adverse-drug reaction, drug-drug interactions can be reduced through medicines reviews and medicines reconciliation.

As long as we have clinicians who hide the name of prescribed medication from their patients; the rate of duplication of therapy, adverse drug reactions and drug-drug interactions will continue to increase. Patients have the right to know the medicines prescribed for them

Medicines reconciliation/review

Medicines reconciliation is a process whereby patients’ medicines are reconciled as they move between different stages of healthcare, from primary–secondary care interface.

Pharmacist-led medication review tend to be more in-depth ,capturing all the essence of patient-centred care as it offers more time for the patient to ask medicine-related questions which enhances concordance.

The role of the pharmacist as a ‘drug expert’ is to complete medicines reconciliation and medication reviews especially for patients taking regular medication for long-term conditions like Hypertension, Diabetes, Arthritis, Asthma, etc.

In a typical Nigerian clinical setting (public and private), when a patient has contact with a clinician, most times, the patient does not have any interaction with a pharmacist. Integrated healthcare is a healthcare model where every member of the healthcare team contributes their own quota towards excellent healthcare delivery.

This true-life story about patient X shows the importance of medicines reconciliation:

Patient X is a 65-year-old man living in Sokoto, with a history of Hypertension. He takes amlodipine 10mg tablets daily. He travels to Lagos for a business meeting and suffers a hypertensive crisis. He gets admitted in a hospital in Lagos, his blood pressure is adequately controlled and he is discharged with two other antihypertensives.

Patient X did not go through the medicines reconciliation process with a pharmacist or another clinician, so when he gets back to Sokoto, he continues to take his newly prescribed antihypertensives in addition to the one prescribed by his doctor in Sokoto. Few days later, he suffers hypotension (low blood pressure) and falls on the stairway at home, breaking his hip, which made his condition worse.

A consultation with a pharmacist during the discharge/admission process could have prevented duplication of therapy, and the patient educated/informed about which medication to stop/continue and also side effects to expect. Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring like methotrexate, diuretics, digoxin etc. Annual blood tests are routinely checked because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.

Education and support for patients on multiple medicines

Evidence has shown that when patients understand the side effects of the medication they take, they are more likely to comply with the dosage regimen. A lot of work needs to be done in the area of patient education and information provided through medicines use reviews. The gains of patient-centred care cannot be overemphasised. All medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes, frailty comes into consideration for some elderly patients as well.

There has been a drive for more social prescribing, motivational counselling and interventions for patients who have suffered medical emergencies or patients with long-term conditions. Evidence has shown that non-pharmacological interventions have a major role to play in achieving overall general health and wellbeing.

Integrated health care approach will reduce the risk of medication-related deaths in Nigeria as well as enhance delivery of outcomes. Clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota for effective healthcare delivery.

Pharmacists are part of the MDT and their expertise need to be utilised more across clinical settings in Nigeria to help prevent medication-related errors and deaths. The role of the pharmacist in medicines optimisation, medicines reconciliation and patient-centred care is once again very vital in healthcare delivery.

• Adaku Efuribe is a clinical pharmacist, an SDG Advocate and a wellbeing coach based in the UK