{"id":32934,"date":"2014-12-08T17:01:53","date_gmt":"2014-12-08T16:01:53","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=32934"},"modified":"2014-12-08T17:16:05","modified_gmt":"2014-12-08T16:16:05","slug":"jeffrey-aronson-happy-50th-birthday-yellow-cards","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/12\/08\/jeffrey-aronson-happy-50th-birthday-yellow-cards\/","title":{"rendered":"Jeffrey Aronson: Happy 50th birthday, Yellow Cards"},"content":{"rendered":"

\"jeffrey_aronson\"<\/a>To London, to celebrate 50 years of the Yellow Card scheme<\/a>. The scheme, which was started by the erstwhile Committee on Safety of Drugs (CSD), and is now run by the Medicines and Healthcare products Regulatory Agency (MHRA), allows health professionals and patients to report suspected adverse drug reactions to medicines, either manually, on a yellow coloured card, or online.<\/p>\n

I am medically of age with the Yellow Cards, having entered medical school in 1964. The first handout we received at the start of materia medica (i.e. clinical pharmacology) was a “yellow peril,” the fourth in the CSD\u2019s \u201cAdverse Reactions Series,\u201d an A4 sheet of paper from which we learned that chloramphenicol caused agranulocytosis and should not be used except in Haemophilus influenzae<\/em> meningitis and typhoid. I became fascinated by therapeutics and pharmacovigilance.<\/p>\n

Over the years I have watched the Yellow Card scheme grow and mature, and it was an honour to be invited to take part (with about 80 others) in a one day symposium on the future of the scheme\u2014one event in the 50th anniversary celebrations.<\/p>\n

Each of\u00a0the\u00a0four sessions included three talks, questions and answers, and round table discussions.<\/p>\n

1. Should Yellow Card reporting be statutorily mandated? The virtually unanimous view was that it should not, although the General Medical Council’s Good Practice guidance states that doctors \u201cmust inform the MHRA about serious suspected adverse reactions to all medicines and all reactions to [Black Triangle] products,\u201d which, given the gloss that \u201cmust\u201d implies \u201can overriding duty or principle,\u201d suggests that they think it should.<\/p>\n

2. How to improve reporting? Suggested incentives and reminders included making Yellow Card reporting part of appraisal and revalidation, adding it to the Quality and Outcomes Framework (QOF), offering prizes and awards, putting the Yellow Card logo on prescription forms, and praising contributions by feedback. Feedback methods included journal articles (perhaps \u201cYellow Card of the Week\u201d in The BMJ<\/em>?), and the use of social media and apps. Education was considered vital, and the roles of clinical pharmacologists and clinical pharmacists, working in tandem where possible, were stressed. Everyone agreed that reporting should be simplified.<\/p>\n

3. How to use the data? Suggestions included analysis by time of onset of the reaction and searching susceptibility markers, such as age and genetic variants. It wasn\u2019t clear what proportion of all adverse events ought to be reported in an ideal system, but under 10%\u2014the current rate\u2014is clearly unacceptable.<\/p>\n

4. The role of patients. Patient reporting has proved highly successful. Everything should be done to encourage it.<\/p>\n

Since many different groups are paying increasing attention to patient safety (i.e. avoiding unsafety), communication across the groups is essential. The Yellow Card scheme could act as a focus for the activities of the disparate groups. Perhaps a single body should have oversight of it all?<\/p>\n

The first minister of state for life sciences, in his keynote address, launched a new simplified electronic reporting scheme. The MHRA also joined the Sign up to Safety campaign<\/a>, to play its part in reducing avoidable harms in the NHS.<\/p>\n

The meeting was run by June Raine with military efficiency. The proceedings were recorded. Rapporteurs took notes. A report will eventually appear.<\/p>\n

So, happy birthday, Yellow Cards! Here\u2019s to the next 50 years.<\/p>\n

Jeffrey Aronson<\/strong> is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences, and president emeritus of the British Pharmacological Society.<\/em><\/p>\n

Competing interests: Jeffrey is the editor of several books dealing with adverse drug reactions, including Meyler’s Side Effects of Drugs: the International Encyclopedia of Adverse Drug Reactions and Interactions<\/em>\u00a0and (with John Talbot) Stephens’ Detection and Evaluation of Adverse Drug Reactions: Principles and Practice<\/em>.<\/p>\n","protected":false},"excerpt":{"rendered":"

To London, to celebrate 50 years of the Yellow Card scheme. The scheme, which was started by the erstwhile Committee on Safety of Drugs (CSD), and is now run by […]<\/p>\n

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