Birmingham as a forerunner in prescribing medicines safely

An estimated 237 million medication prescription errors occur annually in England, costing £1.6 billion and contributing to over 22,000 deaths a year. Adverse drug reactions caused by medicines are also responsible for 1 out of 6 admissions to hospital. Ensuring the safe and effective use of medicines is a critical part of healthcare, particularly with an aging population taking an increasing number of medicines.

For many years researchers from the University of Birmingham have been working to improve medication safety. Pivotal to addressing these challenges is ensuring centralised reliable information for prescribers, exploring the use of AI and technology to predict and reduce adverse drug events, and understanding how electronic prescribing systems and clinical decision support tools can best be implemented.

Birmingham’s contributions have been critical to establishing trustworthy evidence-based sources of information for prescribers that are relied upon to this day. Two key academics whose contributions to drug safety precautions have been essential are Professor Owen Wade and Professor Martin Kendall.

Professor Owen Wade is known as one of the founding fathers of clinical pharmacology and therapeutics in the UK. Professor Wade was Dean of Birmingham Medical School from 1978 to 1984. He wrote some of the earliest papers and books on adverse drug reactions, but his greatest legacy was the transformation of the British National Formulary (BNF), widely regarded as the ‘bible’ used by virtually all doctors, pharmacists and students. Professor Wade moved the BNF from a 3 year hardback publication cycle, to a 6 monthly rapidly updated paperback version, ensuring prescribers had more timely and accurate information to make prescribing decisions.

Martin Kendall, Emeritus Professor of Clinical Pharmacology at University of Birmingham, was the Chair of the Joint Formulary Committee, overseeing the clinical content of the British National Formulary from 2000 to 2008. Keen to address the safety issues of prescribing in children, during his tenure Professor Kendall established the first British National Formulary for Children.

Finding new adverse drug reactions to medicines (Pharmacovigilance) is also an important public health activity. Anyone can report safety issues with a medicine, vaccine or medical devise via the Yellow Card scheme. The scheme is run by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK. Founded in 1964, the Yellow Card scheme still plays a key role in keeping patients safe today, by helping the MHRA identify new safety signals as early as possible. The Yellow Card Centre West Midlands which educates healthcare professionals and the public about the scheme is based in Birmingham, and the past two directors have been University of Birmingham Professors — Emeritus Professor of Clinical Pharmacology, Robin Ferner, and currently Professor Jamie Coleman.

Today, researchers from Birmingham are still looking for ways to make medicines safe for patients who need them. Our School of Pharmacy carries out research to develop safer delivery systems for medicines, works to identify the chemistry that influences adverse drug reactions, researches the safe and effective use of electronic prescribing systems, and contributes to improving global medicines safety through improving pharmacovigilance education and systems.

One of the most impactful projects straddles both research and education. The SCRIPT eLearning programme was launched in 2010 at the University of Birmingham, to enhance the prescribing skills of Foundation trainee doctors, following a General Medical Council study that indicated Foundations doctors had a prescribing error rate of 8-10%. SCRIPT’s success in the West Midlands led to the programme being made available nationally across the UK and the team developed additional portfolios for other healthcare professionals involved in the medication process, including dentists, paediatric specialist trainees, nurses, general practitioners, and pharmacists.

SCRIPT now comprises 146 modules, each covering a wide range of therapeutic topics. Modules are authored, edited, and peer-reviewed by expert healthcare professionals and are regularly updated to ensure they remain current and relevant. The programme is recognised as a best practice resource in the UK and is recommended in professional guidelines and training standards.

In 2023/24 SCRIPT had over 51,000 registered users across a range of disciplines, and over 97% of Foundation trainee doctors engaged with the programme for their prescribing development. Since launch, over 1.2 million modules have been completed across all SCRIPT portfolios. The programme standardises training across the NHS, aiming to reduce medication errors and optimise medicine use for better patient care. It is freely accessible to all NHS staff and all Higher Education Institutions in the UK for undergraduate healthcare teaching.