Storyboard Entry Form 2015
Main author: Alana Adams
Email: [email protected]
Telephone: 02920743880
1. Storyboard title:
The Introduction of a Yellow Card Hospital Champion Scheme in NHS Wales
2. Brief outline of context:
Yellow Card Centre (YCC) Wales is a regional monitoring centre of the Medicines and
Healthcare Products Regulatory Agency (MHRA) and a partner organisation of the All
Wales Therapeutics and Toxicology Centre (AWTTC). Staff at the centre are based at
the Welsh Medicines Information Centre, University Hospital Wales, and AWTTC,
University Hospital Llandough in Cardiff, and comprise medical staff and
pharmacists. The team advise on Yellow Card reporting, and offer education and
training sessions about suspected adverse drug reactions (ADRs) to all healthcare
professionals and patient groups.
The Yellow Card Scheme was established in 1964 in the wake of the thalidomide
disaster and, by collecting reports of ADRs in the UK, provides an early warning of
possible hazards. The scheme provides a vital role in ensuring the continued safety
of medicines.
3. Brief outline of problem:
The number of yellow cards reported from Wales to the MHRA fell by 26% in 2011–
2012, to the lowest number of yellow cards submitted annually for the preceding
ten years.
Previously, hospital pharmacists were the group responsible for submitting the
highest number of yellow cards. However, in 2011–2012 reports submitted by
hospital pharmacists fell by 37% when compared to the previous year.
4. Assessment of problem and analysis of its causes:
Around 6.5% of admissions to UK hospitals are related to ADRs and the projected
annual cost of ADRs to the NHS is £466 million.
It was believed that the reasons for the reduction in reports were multi-factorial and
included lack of time, low motivation, confusion over what to report and how to
report, different reporting mechanisms and recent legislative changes.
Following discussions, the YCC Wales team agreed that increased support across
Wales was required for education and training, support and advice on yellow card
completion and submission to MHRA. From this, the yellow card champion scheme
evolved.
The team prepared and submitted a proposal to the All Wales Chief Pharmacists
Committee (AWCPC) recommending the introduction of a yellow card hospital
champion to each health board in Wales, in an attempt to improve reporting rates
and awareness amongst hospital-based reporters.
The role specification for the hospital champion scheme was agreed by the AWCPC
in November 2012 with the following aims:
• To act as an information resource, provide guidance and deal with local
queries on pharmacovigilance and yellow card reporting
• To proactively assist other colleagues in the completion of yellow cards
• To provide education and training sessions on pharmacovigilance to hospital
staff
• To increase local publicity of the yellow card scheme
• To keep up to date with legislative changes at the MHRA and European
Medicines Agency (EMA), and communicate these to the relevant parties
5. Strategy for change:
YCC Wales submitted a proposal to the AWCPC recommending the introduction of a
yellow card hospital champion to each health board in Wales, in an attempt to
improve reporting rates and awareness amongst hospital-based reporters.
In March 2013, 14 nominated volunteer champions from health boards across Wales
(including a nomination from Public Health Wales) attended a training session run by
staff of YCC Wales.
The all day session covered training on the background of the scheme, ADRs and
their classification, how to complete a yellow card and the role of the yellow card
champion. In addition, champions attended a workshop on the barriers to
completing a yellow card and how to overcome these. Other topics included
legislative changes and new developments. Champions were provided with a
resource pack, which included a training package and promotional material to be
used in their local areas, ensuring that consistent messages were delivered across
Wales.
6. Measurement of improvement:
The changes were measured quantitatively by the number of yellow card reports
received by MHRA from Wales.
All Yellow Cards are reported direct to the MHRA in London, analysed and details
sent to YCC Wales quarterly. These data can be further categorised by reporter type
and health board. Results were monitored on a quarterly basis and fed back to each
of the champions, broken down by individual health boards.
At the end of the 12-month period, the data were compared to the previous annual
figures by reporter type and overall health board figures.
A total of 1,177 reports of suspected ADRs originated from the YCC Wales region in
2013–2014. This represents an increase of 81% when compared to 2012–2013. The
chart below shows the total number of reports over time.
Total ADR reports in Wales
1600
1415.3
Number of ADR reports
1400
1200
977.6
1000
800
539.9
600
UCL
400
Mean
200
LCL
2013/14
2012/13
2011/12
2010/11
2009/10
2008/09
2007/08
2006
2005
2004
0
Year
Since the scheme was launched the reporting rate amongst hospital staff has
increased. This has been reflected in the total number of reports submitted. It is
important to note that initiatives targeting other reporters have been running
concurrently with the hospital champion scheme.
The following chart shows the number of reports made by hospital pharmacists
annually for the past nine years.
Number of ADR reports from hospital
pharmacists
350
Number of ADR reports
300
250
179
200
Median
150
100
50
2013/14
2012/13
2011/12
2010/11
2009/10
2008/09
2007/08
2006
2005
0
Year
The results for 2013–2014 show an increase in reports from hospital pharmacists of
134% to 330 when compared to the previous year. This represents the highest
number of reports received from hospital pharmacists in Wales since 1997, when
hospital pharmacists first became able to report via the yellow card scheme. Over
the past nine years there has been wide variation in hospital pharmacist reporting
rates and the aim of the scheme going forward will be to maintain, if not improve,
reporting rates.
Thirty-six training sessions were carried out over the 12-month period by the
champions, reaching a total of 438 participants.
7. Effects of changes:
The increase in the number of yellow cards submitted in itself means that ADRs are
reported and therefore the potential for continued prescribing of harmful medicines
is reduced. The actual difference to individual patient groups is difficult to quantify
but it is assumed that by reducing ADRs to medicines, patient care will be safer,
admissions to hospitals will be reduced, duration of hospital stay will be reduced and
overall costs to the NHS in Wales will be reduced. These benefits are long-term and
UK-wide.
The Yellow Card Hospital Champion Scheme has enabled YCC Wales to reach a wider
audience throughout all health boards in Wales. Before the scheme was launched it
was anticipated that the champions would target hospital-based reporters; however,
several champions have also participated in training sessions with community-based
reporters including GPs and patient groups.
One of the challenges of the work was ensuring support initially from the Chief
Pharmacists in Wales, alongside a very busy schedule of work commitments.
Additional challenges for the champions included finding additional time to carry out
this work, ensuring engagement with healthcare professionals to attend training
sessions, and sometimes being faced with challenges from colleagues about
reporting of ADRs.
8. Lessons learnt:
This scheme has worked very well in Wales and the role specification of the
champion was very clear from the outset of the improvement work. Getting this
specification agreed at an early stage was crucial. In future, it would be valuable to
include community-based champions to ensure adequate coverage of colleagues in
primary care. Phase two of the improvement work aims to develop the scheme in
this area. Including patients in the improvement work at an early stage is something
that would be beneficial in the future.
9. Message for others:
A champions scheme works if the appropriate individuals are chosen, trained,
empowered and given a clear mandate. This approach enables large geographical
areas (in this case the whole of Wales) to receive consistent messages so that NHS
Wales staff and patients benefit together and there is improved quality and reduced
variation.
10. Please summarise how your entry reflects the principles of
prudent healthcare:
One of the aims of prudent healthcare is better outcomes and safer care for
patients; one of the ways we can minimise avoidable harm is by having a strong
reporting culture regarding ADRs, thus ensuring all healthcare professionals eligible
to report do report such events via the yellow card scheme and use this information
to further drive improvement. Patient safety is a key component of prudent
healthcare, and information gathered by the scheme helps prescribers to increase
patients’ awareness of the possible effects of the medicines they are using, and thus
further enhances safety. Having champions who are sharing and delivering the same
consistent messages and training across Wales enhances safety, reduces variation
and promotes equity between the people who provide and use services.
YCC team includes;
Dr A M Thomas, Professor P A Routledge, Dr J P Thompson, Dr C V Krishna, Dr J
Coulson, Dr R Bracchi, Mrs F J Woods, Mrs A Adams, Mrs E Carey.
The NHS Wales Awards are organised by
the 1000 Lives Improvement service in
Public Health Wales.
www.1000livesi.wales.nhs.uk