HIQA finds effective governance essential in first medication safety inspections

Date of publication:

The first inspection reports on medication safety in public acute hospitals have been published today by the Health Information and Quality Authority (HIQA). Inspections found that where effective medication safety governance arrangements were in place, patients were better protected from potential harm related to medication use.

HIQA’s medication safety monitoring programme, which commenced in November 2016, aims to examine and positively influence the adoption and implementation of evidence-based practice in public acute hospitals regarding medication safety. HIQA monitors medication safety against the National Standards for Safer Better Healthcare. HIQA’s Guide to the Health Information and Quality Authority’s Medication Safety Monitoring Programme in Public Acute Hospitals outlines the requirements for service providers under phase one of the inspection programme.

Sean Egan, HIQA’s Acting Head of Healthcare Regulation, said: “Error associated with medication use constitutes one of the major causes of patient harm in hospital. Medication safety should be a priority area for all acute hospitals as they seek to ensure a high-quality and safe service for patients.”

The seven inspections were carried out between November and December 2016 in the following hospitals: Bantry General Hospital, Connolly Hospital, Naas General Hospital, Nenagh Hospital, Mater Misericordiae University Hospital, Sligo University Hospital and University Hospital Waterford. HIQA found a wide variation in the medication safety arrangements in place across the seven hospitals.

Sean Egan continued: “These inspections found that while all hospitals have some scope for further improvement, some hospitals were well organised to ensure safer use of medicines for patients, and had good arrangements in place to monitor, identify and manage risk associated with medicines use.”

A number of examples of good practice in relation to medication safety were found during these inspections. For example in Naas General Hospital, the Mater Misericordiae University Hospital and Sligo University Hospital HIQA found that; medication safety was effectively supported by senior management in the hospitals, a formal and structured medication safety programme was established, an open incident and near-miss reporting culture was promoted and a process was in a place for learning from medication-related incidents, medication safety audits were carried out and learning was shared with all staff, up-to-date medication policies were in place, and good leadership was shown from key clinical staff to support medication safety.

“However, these inspections also found that learning from hospitals that have more advanced medication safety programmes in place should be shared nationally, as more needed to be done in other hospitals to better promote safer use of medicines. A key building block for any medication safety programme is the presence of an effective governance committee – usually known as a Drugs and Therapeutics Committee – which oversees how the hospital anticipates, monitors, identifies and responds to risk related to medicines use. As a first step, poorer performing hospitals in these inspections need to improve the functioning of these committees and, where possible, look to link in with other hospitals to benefit from their experience. Some hospitals also lack some necessary resources which would assist in promoting greater safety in the use of medicines, and further support in this regard may help to assist in improving medication safety.”

Read the reports for Bantry General Hospital, Connolly Hospital, Naas General Hospital, Nenagh Hospital, Mater Misericordiae University Hospital, Sligo University Hospital and University Hospital Waterford on www.hiqa.ie.


For further information please contact:
Marty Whelan, Head of Communications and Stakeholder Engagement
01 8147480 / 086 2447623 mwhelan@hiqa.ie

Notes to Editor:

  • Medication safety has been identified internationally as a key focus for improvement in all healthcare settings and it is estimated that on average, at least one medication error per hospital patient occurs each day.[1] While most of these errors do not result in patient harm, in a small but significant number of cases patient harm does occur.
  • Recent research on medication use in the health system found:
    • 26% of Irish people over 50 years of age use five or more medicines daily[2]
    • up to 20% of readmissions to hospital within a year of discharge are medicines-related[3]
    • up to 8% of all emergency hospital admissions in Ireland are medicines-related[4]
    • 6% of hospital discharge prescriptions were found to have a potentially severe medication prescribing error[5]   
  • HIQA’s medication safety inspections evaluated the medication safety structures in place in hospitals under the following six themes:
  1. Governance and risk management
  2. Audit and evaluation
  3. Medication safety support structures and initiatives
  4. Person-centred care
  5. Policies procedures and guidelines and access to information
  6. Training and education
  • Governance, as referred to in this work, describes how hospitals arrange themselves to ensure that patient safety is maintained when using medicines, and that the hospital has good systems in place to anticipate, monitor, identify and manage risk related to medication use.

[1] Kohn, Linda T, Janet M, Corrigan, Molla S, Donaldson. To Err is Human: Building a Safer Health System. Washington: Institute of Medicine; 1999. Available online from:https://www.nap.edu/download/9728#

[2] The Irish Longitudinal Study on Ageing. The over 50s in a changing Ireland - economic circumstances, health and well-being. 2014.

[3] Davies E, Green C, Mottram D, Rowe P, Pirmohamed M. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. British Journal of Clinical Pharmacology 2010; 70, pp.749-55.

[4] Ahern F, Salm L, Lynch D, McCarthy S. Determining the frequency and preventability of adverse drug reaction-related admissions to an Irish University Hospital: a cross-sectional study. Emergency Medicine Journal 2014; 31[1], pp.24-9.

[5] Grimes T, Deasy E, Allen A, O'Byrne J, Delaney T, Barragry J, et al. Collaborative pharmaceutical care in an Irish hospital: uncontrolled before-after study. BMJ Quality & Safety 2014; 23, pp.574-83.