Visual impairment and medication safety: a protocol for a scoping review

Visual impairment (VI) refers to a condition where the person has a reduction in their visual acuity or field of vision, which cannot be corrected by spectacles or contact lenses. It is estimated to affect 285 million people, 39 million of whom are blind [1]. The number of individuals with a visual impairment in the UK was estimated a few years ago to be around 1.93 million [2]: about 3% of the adult population [3]. People can be visually impaired from birth, childhood, early adulthood or later in life. People over 50 represent the largest group of blind and visually impaired people, which currently stands at 82% of the blind and visually impaired population worldwide [1]. Those with visual impairment or blindness are reported to be marginalised in terms of accessing healthcare information and facilities, and they are known to receive sub-optimal healthcare [4]. Marginalised patients, such as those with visual impairment, are subject to health inequities and increased risk for patient safety incidents in comparison to the general population [5]. Studies also suggest that people with VI are more at risk of social isolation [6], which could further perpetuate their increased risk of being affected by patient safety incidents. Those with visual impairment are known to be at an increased risk of experiencing medication errors [7] compared to those without visual impairment. This could be for a number of reasons, such as being unable to open medication containers, being unable to differentiate various types of medication containers, being unable to differentiate various types of tablets/capsule dosage forms, forgetting to take medication on time and taking the wrong medication [7, 8]. Medicine-taking is complex and requires various and coordinated forms of work on the part of the patient and those in their networks. People with VI may not be able to perform their medicine work as easily as those without VI. The importance of supporting visually impaired patients to help improve their medication safety was further strengthened in 2016 when NHS England introduced the Accessible Information Standard (AIS), which required that the information and communication needs of disabled patients are proactively addressed in all aspects of NHS healthcare, including the dispensing of medicines [9]. Digital solutions are increasingly used to improve people’s safety and quality of life and VI people are frequent users of the Internet to support their wellbeing [10, 11]. There are concerns about the cost and lack of universal availability of this technology [12], and it is less clear how digital technologies, managed by individuals, can not only empower visually impaired people, but also safeguard them from harm related to medication management [13].

To understand the issues of medication safety for VI people, it is essential to gather evidence from their experience and consider that alongside previous research. We have undertaken focus groups with VI people identifying a number of key themes, including the variation in VI and consequences for medication safety. We propose conducting a scoping review of existing research evidence to increase the understanding of VI and medication safety.

The issues of medication safety for people with VI depend on the nature/severity of the visual condition. Previous research conducted by the team [14] identified that health and social care practitioners lack knowledge and understanding of VI, but many people with VI feel confident to explain what works for them and find “work arounds” to maintain safety in medicine taking.

With an ageing population in many developing countries, the number of people with age-related vision loss is likely to increase. The scoping review aims to identify the specific medication safety issues for people with visual impairment and how these patients manage their medicines to mitigate against medication safety issues.

Firstly, “to examine the extent, range and nature of research activity; this type of rapid review might not describe research findings in any detail but is a useful way of mapping fields of study where it is difficult to visualise the range of material that might be available.” The second common reason is determining whether a systematic review is feasible and of value. The third and fourth common reasons seem to describe scoping reviews that are not exploratory or preparatory, but done in their own right. Other authors similarly state that scoping reviews are used to synthesise research evidence and are often used to map existing literature in a given field in terms of its nature, features and volume. As such, scoping reviews have also been called “mapping” reviews. Finally, a map of the range of the available evidence can be undertaken as a preliminary exercise prior to the conduct of a systematic review. If we wish to conduct other more systematic reviews, then this review will allow us to see where and if that might be possible.

This review will summarise the literature relating to visual impairment and medication safety. Four electronic bibliographic databases will be searched, using combinations of two key blocks of search terms: visual impairment and medication safety. The findings from this review will provide an evidence base for further work in this area. It will increase understanding of the issues that visually impaired people face in relation to medication safety and ultimately improve quality of health care.