NIA presentation

At a NIA-meeting (Dutch Industry Pharmacists Association) a presentation was given about GIMS foundation.

The theme of much needed improvements in Medication Safety in LMIC’s was picked up well.

Medication Safety in Resource-Limited Settings?

Beneath a fine abstract from a presentation at the Second Global Ministerial Summit on Patient Safety :

Medication Safety in Resource-limited Settings

Priyadarshani Galappatthy, Prof. Dr., Faculty of Medicine, University of Colombo, Professor and Head Department of Pharmacology, Sri Lanka

Abstract: Medication safety is a major concern contributing to patient safety particularly in resource-limited settings (RLS). Absence of reliable estimates of prevalence of adverse drug events, costs involved, causes of medication errors and evidence of effective interventions in RLS is a major limiting factor for ensuring medication safety in RLS.

Although there are nearly five times as many people living in Lower and Middle Income Countries (LMICs), the number of annual adverse drugs events calculated (6 million) is almost equal to the number of adverse drug events occurring in high income countries (5.8 million). Some key problems identified include lack of reliable data, safety culture, reporting systems, poor reporting, poor legibility of hand written prescriptions, absence of electronic support systems, limited number of healthcare professionals to serve the large numbers of patients, lack of clinical pharmacists services, higher prevalence of counterfeit and substandard medicines (up to 20-30% in some LMIC countries), availability of large numbers of generics of the same drug, lack of stringent drug regulatory mechanisms, poor medication literacy and absence of patient support mechanisms.

Possible interventions include identification of the baseline situation on epidemiology and causes of adverse drug events in RLS, the drugs involved in RLS, their severity, amenability of drug events to prevention, implementing routine quality testing of drugs throughout the drug supply chain, implementing successful national drug regulation, increasing the capacity of regulators and providing technological support and expertise for detecting and managing drug related issues.

Expected outcomes would be establishing the baseline on the epidemiology of medication incidents in RLS, implementing systems and practices for medication safety and significant reduction in medication errors (e.g. up to 50%) in the next 5 years. Future direction is towards a multidisciplinary approach with active involvement of all stakeholders in preventing medication incidents. Developing and implementing an individualized action plan for each country for the problems identified based on local data would be the key to ensuring medication safety in RLS.

Keywords: medication safety, medication errors, resource limited settings, lower-middle income countries, prevention

Speaker Information: Priyadarshani Galappatthy is a consultant physician, professor in Pharmacology and Head, Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka.

For the complete document use link:

Abstracts_and_Speakers_Patient_Safety Ministers Summit 2017


WHO steps in as well!

WHO Launches Global Effort to Halve Medication-Related Errors in 5 Years

News release

WHO today launched a global initiative to reduce severe, avoidable medication-associated harm in all countries by 50% over the next 5 years.

The Global Patient Safety Challenge on Medication Safety aims to address the weaknesses in health systems that lead to medication errors and the severe harm that results. It lays out ways to improve the way medicines are prescribed, distributed and consumed, and increase awareness among patients about the risks associated with the improper use of medication.

Medication errors cause at least one death every day and injure approximately 1.3 million people annually in the United States of America alone. While low- and middle-income countries are estimated to have similar rates of medication-related adverse events to high-income countries, the impact is about twice as much in terms of the number of years of healthy life lost. Many countries lack good data, which will be gathered as part of the initiative.

Globally, the cost associated with medication errors has been estimated at US$ 42 billion annually or almost 1% of total global health expenditure.

“We all expect to be helped, not harmed, when we take medication,” said Dr Margaret Chan, WHO Director-General. “Apart from the human cost, medication errors place an enormous and unnecessary strain on health budgets. Preventing errors saves money and saves lives.”

Every person around the world will at some point in their life take medicines to prevent or treat illness. However, medicines do sometimes cause serious harm if taken incorrectly, monitored insufficiently or as the result of an error, accident or communication problems.

Both health workers and patients can make mistakes that result in severe harm, such as ordering, prescribing, dispensing, preparing, administering or consuming the wrong medication or the wrong dose at the wrong time. But all medication errors are potentially avoidable. Preventing errors and the harm that results requires putting systems and procedures in place to ensure the right patient receives the right medication at the right dose via the right route at the right time.

Medication errors can be caused by health worker fatigue, overcrowding, staff shortages, poor training and the wrong information being given to patients, among other reasons. Any one of these, or a combination, can affect the prescribing, dispensing, consumption, and monitoring of medications, which can result in severe harm, disability and even death.

Most harm arises from systems failures in the way care is organized and coordinated, especially when multiple health providers are involved in a patient’s care. An organizational culture that routinely implements best practices and that avoids blame when mistakes are made is the best environment for safe care.

The Challenge calls on countries to take early priority action to address these key factors: including medicines with a high risk of harm if used improperly; patients who take multiple medications for different diseases and conditions; and patients going through transitions of care, in order to reduce medication errors and harm to patients.

The actions planned in the Challenge will be focused on four areas: patients and the public; health care professionals; medicines as products; and systems and practices of medication. The Challenge aims to make improvements in each stage of the medication use process including prescribing, dispensing, administering, monitoring and use. WHO aims to provide guidance and develop strategies, plans and tools to ensure that the medication process has the safety of patients at its core, in all health care facilities.

“Over the years, I have spoken to many people who have lost loved ones to medication-related errors,” said Sir Liam Donaldson, WHO Envoy for Patient Safety. “Their stories, their quiet dignity and their acceptance of situations that should never have arisen have moved me deeply. It is to the memories of all those who have died due to incidents of unsafe care that this Challenge should be dedicated.”

This challenge is WHO’s third global patient safety challenge, following the Clean Care is Safe Care challenge on hand hygiene in 2005 and the Safe Surgery Saves Lives challenge in 2008.

‘GIMS Pro’

As GIMS foundation we have a focus on the improvement of Medication Safety in LMIC’s.  IT is one of the ways to help pharmaceutical professionals to be able to perform these tasks towards their community.  That is why we are in the process of creating ‘GIMS Pro’.


Create (locally customized and serviced) open source IT products (software and a national product database) focussed upon pharmaceutical professionals which will be able to help to enhance Medication Safety for the general public in LMIC’s.

These IT products require nationally organized supporting entities for education, technical support, maintenance and further national development.

Ideally these entities are, or will be, incorporated in a national Professional Pharmaceutical Society, or likewise, so the professionals themselves can direct the desired functional IT- and organisational goals/destination, and shall have no commercial goals.


-The specific national situation (technical, judicial, economical, safety and professional attitude) is sufficiently adequate to start the process.

-GIMS foundation operates as the party which supplies the licence (free of charge) for the standardized IT-products.

-GIMS foundation delivers the corresponding consultancy in the process of realising the nationally desired versions and entities.

-The national entities are, for their territory, the owner of the nationally developed ‘GIMS Pro’-versions.

-GIMS foundation functions after national implementation as a GIMS-family in which users are connected and further developments are guided.


-Internet based,

-open source software,

-both a product database and corresponding software is needed,

-product data base derived from the Dutch ‘G-standaard’ and adepted to local situation,

-ideally a patient file database is possible,

-the software should be very flexible in the desired/operational functionalities,


-Internet based,

-open source software,

-both a product database and corresponding software is needed,

-product data base derived from the Dutch ‘G-standaard’ and adepted to local situation,

-ideally a patient file database is possible,

-the software should be very flexible in the desired/operational functionalities,

-functionalities can be:

*Dosage control (age and sex dependent)

*Checks on Interactions between co-used medicines

*Checks on Contra-indications:


#High blood pressure


#HIV, TB, Malaria



#Kidney function

*(pro-)active searches in case of the availability of adequate patient files


What say others about GIMS?

“I would like to recommend the importance of the GIMS-Foundation initiative. In general there is a focus on accessability, affordability and quality of the medication in low and middle income countries, but the actual consumption of medication poses new and other questions. Questions wether the right person uses the right medicine, in the right dose, for the right amount of time, in compliance with the advises. The use of medication is always a balance between the expected benefits and the potential side-effects. Lack of balance threatens the patient. Disregarding the medication safety undermines the benefits, is a potential hazard, and is a waste of money. Monitoring medication safety is a key element in the work of health care professionals. The World Health Organization stimulates countries all over the world to establish national bodies for rational use of medicine in particular to find a balance between quality, safety and costs of the actual use of medication. The GIMS Foundation contributes to this balance by stimulating initiatives to guarantee the medication safety and is a partner for local, regional and national organizations. The Dutch Institute for Rational Use of Medicine (IVM) has been very successful in the last 20 years to create the best benefit/risk ratio in the use of medicines in the Netherlands, leading to for example an optimal use of antibiotics and therefore the lowest level of antibiotic resistance in the world. We achieved this in close cooperation with general practitionars, specialists and pharmacists. We thus support the work of the GIMS Foundation and we are willing to cooperate in every possible way.”

Drs. Ruud Coolen van Brakel, director IVM, Dutch Institute for Rational Use of Medicine

Medicine related hospital admissions

In the beginning of 2017 a follow up report (of the HARM study and HARM Wrestling report, see GIMS library) was released which made clear that:

For patients over 65 years:

Investigation period was 2008-2013,

10% of the hospitalisations were medicine related,

50% of these were potentially avoidable!

for the Dutch situation that comes down to about 50.000 potentially avoidable hospitalisations per year!

For report:

eindrapport-vervolgonderzoek-medicatieveiligheid (1)

Electronic prescription is a must have

In a just relased Dutch Health Inspectorate Investigational  Report titled,  in translation,  ‘Safe prescription must (be) better’ it is stated as an absolute demand that, in order to minimize errors etc, the prescription must be electronical.

veilig-voorschrijven-moet-beter 2017

LMIC’s should also be able to implement some form of electronic prescribing (and dispensing) system in order to help prevent health care risks, from the unsafe prescription/dispensing and use of medicines, for their populations. At the GIMS foundation we are currently working on such a (broadly applicable) IT-tool.

The GIMS model 1.0

The ‘GIMS model for screening and rating Medication Safety in a country 1.0’ is out!

This analytical tool with a new and comprehensive approach, regarding all the actors and factors influencing Medication Safety in a country,  is of use for scientific and pharmaceutical policy research as it identifies the actual status and brings focus on possible improvements.

GIMS foundation invites fellow researchers to comment.

GIMS model version 1.0