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Posted 17 Dec 2014 in Medication

Leading into the summer holiday season the spotlight of the Open for better care campaign remains firmly focused on medication safety, and high-risk medicines in particular. The theme for January and February is partnership with consumers and their whānau. Often the patient or their close family and friends are the last line of defence in preventing a potential error becoming a reality. For this defence to work they must have a clear understanding of what to look out for and who to go to for help.

For those unlucky people who become unwell or are injured while on holiday the treating health care team will likely be starting from scratch. It is unlikely that they will have met the patient or their family before and they may well struggle to access information from the patient’s normal health care team. In this situation it becomes even more important for the patient and their family to have a good understanding of their medicines.

A few of the high-risk medicines really stand out with respect to the need for partnership.

Insulin comes in a range of formulations. Confusion between long acting, mixed, and rapid acting insulins has been a cause of a number of serious harms and a large number of near misses. Take care to define the preparation exactly. If the patient says the solution you are about to give them looks different, its clear when it should be cloudy, stop, listen, and check. Diabetes is a chronic disease and the patients and their families should be the experts.

Post-operative pain is often the first and only time a patient has access to opioids. The recently reported-on national patient experience survey was notable for two things. Firstly, patients are mostly very satisfied with their care. Secondly, 40 percent are discharged home without an adequate understanding about the side effects of their medicines. Not understanding how to manage short-term prescription of opioids for acute pain is inherently dangerous. Hospitals need to do better in this area.

Monitoring for the anticoagulant effect of warfarin is straightforward. The difficulty is being clear about who is the patient’s ‘go to’ person. Who is taking responsibility for checking that the patient is tested at the right times and for checking the INR results are in the desired range? The riskiest times are at the transitions in care between hospital and community, and when warfarin therapy is first started, the patient is not familiar with the medicine and the monitoring. Few medicines better highlight the value of good partnership with consumers and their whānau than warfarin.

Dr John Barnard, Medication Safety Clinical Lead.