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How community pharmacy can give medicines the yellow card

Community pharmacy patient safety expert Janice Perkins explains the importance of reporting adverse reactions to medicines and devices

What’s the first thing that comes to your mind when you hear the words ‘yellow card’? Do you think of a football referee giving a player a caution, or a suspected adverse drug reaction?

Pharmacy professionals speak to their patients about the side effects of their medicines nearly every day; after all, it’s a key part of providing fantastic person-centred care. But how often do you report those side effects via the Medicines and Healthcare products Regulatory Agency’s (MHRA) yellow card scheme?

C+D’s recent poll revealed that around a third of 107 community pharmacists said they had submitted a report in the previous year. However, around half had never submitted a report, or did so over five years ago.

By definition, the nature of what is being reported – adverse drug reactions – should hopefully be quite rare. So, while this is perhaps not a huge cause for concern, there’s definitely still room for us all to do more in the sector, especially in terms of awareness raising among your pharmacy team and your patients.

Through the work of the Community Pharmacy Patient Safety Group, we know that an open and inclusive approach is the best way to learn from incidents and improve care. We all need to maintain our focus on patient safety, and be confident in using the yellow card scheme, which monitors not just side effects, but also defective and counterfeit medicines, adverse device incidents, and safety concerns for electronic cigarettes.  

There are a few simple, easy-to-apply steps that teams can take to play your part in building the best possible picture of medicine side effects.

Download, use and promote the yellow card app

This fabulous app means you can now receive news updates from the MHRA, and report medicine side effects in real time. This is so much easier than trying to locate the paper copy in the back of your BNF or logging on to the website. You can download it from the Apple App Store or Google Play Store – if I can do it anyone can.

One key feature of the app is the ability to create a ‘watch list’ of medicines for which you can receive news and alerts – and this would be a good thing to suggest patients do too. You can view the total number of yellow card reports made for medicines of interest, and access any previous reports you have submitted through the app.

Support this year’s yellow card campaign

This year’s social media campaign to raise awareness about the importance of discussing and reporting suspected side effects ran this week (November 1-23). It’s theme places an emphasis on the safe use of medicines for babies, children, and pregnant and breastfeeding women.

Last year’s campaign contributed to an increase in reporting of 16% in the UK, with the campaign messages reaching over 2.5 million people. You can watch the videos and resources to support the campaign on the MHRA resource hub, or by following the MHRA on Twitter @MHRAGovUK.

Always report black triangle medicines

A black triangle symbol ▼ is assigned to any medicine which requires additional safety monitoring. This could be a new active substance or biosimilar, a new combination, a drug drug-delivery system, or an established medicine which is used in a new patient population. 

Additional monitoring can help bring any previously unrecognised side effects for newer products to light as quickly as possible. It’s also an important way to ensure the benefit/risk profile established during clinical development is up to date. 

One black triangle medicine you’ll have heard a lot about recently is valproate. It’s only through the reporting of side effects and adverse events that we now recognise the risks associated with this medicine.  

Make use of NMS reviews

An easy way to conduct additional monitoring for black triangle medicines is to ensure any patient you counsel who is prescribed these medicines is offered regular medication reviews and follow-up reviews. The new medicine service can be a particularly good way to review any medicine which is new to the patient or the market.

Sign up for drug safety updates

The MHRA’s drug safety update is a fantastic way to stay in the loop on medicine safety matters, including any insights the MHRA has gathered through yellow card reports. In fact, the way in which many pharmacists became aware of the new requirements around valproate was through this regular newsletter.

You can sign up for drug safety updates here. It can be a great source of information for future CPD cycles – and could form part of your revalidation submission.

Janice Perkins is chair of the Community Pharmacy Patient Safety Group and superintendent at Well Pharmacy

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