HIQA has published four inspection reports on medication safety in public acute hospitals.
Inspections took place between January and March 2019 at Midland Regional Hospital, Tullamore; Mercy University Hospital, Cork; Cappagh National Orthopaedic Hospital, Dublin; and St Columcille’s Hospital, Dublin.
The Authority monitors medication safety in hospitals against the National Standards for Safer Better Healthcare. Hospitals were inspected under HIQA’s medication safety monitoring programme, which this year has included an additional focus on high-risk medicines and high-risk situations.
Midland Regional Hospital Tullamore, 22 January 2019
On the previous inspection, Midland Regional Hospital, Tullamore had the required governance structures and arrangements in place for oversight of medication safety.
However, during this inspection HIQA found governance and oversight of medication safety were impacted by “unplanned reductions” in pharmacy resources. “As a result, the Pharmacy and Therapeutics Committee was not functioning in line with its terms of reference, which had a direct impact on the provision of clinical pharmacy services and medication reconciliation. Medication incident reporting had significantly decreased since the last inspection and there was a lack of analysis, trending and tracking of medication safety incidents in the previous year,” according to the Authority.
Despite these issues, the hospital’s pharmacy department continued to provide a “responsive service for staff and patient review within its limited resources”.
The hospital had identified high-risk medications in use and had implemented a combination of risk reduction strategies to mitigate risk associated with these medications. Inspectors found staff had a good awareness of these in clinical areas visited.
There was a system in place for the approval of new medicines, an approved list of medications (formulary) and inspectors saw easily accessible evidence-based medication information sources in clinical areas.
HIQA advised that hospital management must, as a priority, work towards re-establishing the services required for medication safety and put in place contingency arrangements where required. “The medication safety programme should be restored, directed by a medication safety strategy, to ensure that the considerable efforts taken towards improving medication safety over a number of years are not lost due to current challenges.”
Mercy University Hospital, 22 February 2019
The Mercy University Hospital Drugs and Therapeutics Committee had the required governance structures and arrangements in place to oversee medication safety, according to HIQA. However, gaps identified during the last medication safety inspection of this hospital, such as the introduction of an approved list of medications (formulary) and the development of a medication safety strategy, had not been progressed.
“The hospital had implemented some risk-reduction strategies for high-risk medications,” stated HIQA. “However, opportunities to implement better, higher-leverage strategies to protect patients against the harm associated with high-risk medications were missed by the hospital in line with national and international evidence, and in comparison to other Irish hospitals. This was particularly evident in relation to the availability and storage of concentrated electrolytes and anticoagulants.”
Analysis and trending of medication safety incidents was carried out and there was a consistent improvement in the overall rates of medication safety incident reporting since the last inspection.
Clinical pharmacy services were available to all inpatient units, with the exception of the paediatric and intensive care units, “which may pose a risk to patient safety”. The hospital had a system for the approval of new medications and staff had access to up-to-date information on medications in clinical areas visited. Medication reconciliation was prioritised for patients under the care of a geriatrician.
“Overall, the hospital needs to re-establish the clinical pharmacy service in all clinical areas and renew focus on medication safety across the hospital. This will ensure that medication safety is a priority and protect patients from avoidable harm associated with medication use,” according to the Authority.
Cappagh National Orthopaedic Hospital, 27 February 2019
Cappagh National Orthopaedic Hospital had the required governance in place for oversight of medication safety, found HIQA. There was a medication safety programme in place, which proactively targeted improvement with high-risk medications. While the hospital did not have a long-term strategy for medication safety, inspectors saw evidence that the hospital was responsive to medication safety issues identified. Auditing and monitoring of medication safety were aligned to the medication safety programme and a quality improvement plan.
“Clinical pharmacy services were available to all patients on inpatient wards. The hospital had a comprehensive policy on high-risk medications and had implemented a combination of low, medium and high-leverage risk reduction strategies which were observed in practice. The hospital had an approved list of medications (formulary) and a system in place for the approval of new medications.
“Inspectors found opportunities for improvement in the quality control of printed medication information and in the provision of medication guidelines. There was also scope for improvement in the management and audit of some high-risk medications and in medication safety incident reporting, which had decreased in recent years.”
Overall, Cappagh National Orthopaedic Hospital had established governance structures and systems in place for medication safety and high-risk medications which were relevant to the specialised services provided.
“The hospital should continue to work towards improving medication safety practices by addressing the findings of this inspection report and progressing initiatives identified through its own monitoring of practices in place,” stated HIQA.
St Columcille’s Hospital, 21 March 2019
St Columcille’s Hospital had the required governance structures for medication safety and systems in place for high-risk medications which were relevant to the services provided. The hospital’s annual medication safety plan outlined its aims and objectives for medication safety, and implementation of the 2018 plan was evident to inspectors.
Risk-reduction strategies had been implemented for high-risk medications and situations in areas inspected, which were appropriate to the patient population and medications in use in the hospital. The number of medication safety incidents, reported mostly by pharmacists, continued to increase each year, and analysis of medication incidents was used to implement change.
Clinical pharmacy services were available on all inpatient units and pharmacists undertook medication reconciliation for patients on admission. There was an approved list of medications (formulary), adapted from another hospital, and a system for the approval of new medications.
The approach to medication safety could be enhanced by developing a medication safety strategy to clearly articulate the short and long-term operational goals. The hospital should continue to work towards improving medication safety practices by addressing the findings of the inspection report and progressing initiatives identified through its own monitoring of practices, stated HIQA.