Two inspection reports on medication safety in public acute hospitals have been published today by the Health Information and Quality Authority (HIQA). HIQA monitors medication safety in hospitals against the National Standards for Safer Better Healthcare. Inspections were carried out in May 2017 at University Hospital Limerick and Tallaght Hospital, Dublin.

The two inspections identified considerable variation in the arrangements in place in each hospital to ensure medication safety. Tallaght Hospital had a well-developed and innovative medication safety programme in place. However, the inspection at University Hospital Limerick found that governance arrangements relating to medication safety at hospital and group level were fragmented in approach and underdeveloped. This has resulted in the relative lack of effective systems in place to ensure reliable medication safety at the hospital.

Tallaght Hospital, Dublin

An announced inspection of Tallaght Hospital, Dublin, was carried out on 10 May 2017. HIQA found that the hospital had a long established medication safety programme in place, which was supported by effective governance and oversight of medication safety in the adult services. The Drugs and Therapeutics Committee had initiated multiple proactive measures to enhance medication safety and to support prescribers. For example, a team-based medication reconciliation programme was introduced to improve care and reduce the rate of serious adverse medication events. This programme facilitated medication reconciliation by clinical pharmacists and physicians at admission, during inpatient care and at discharge. The hospital had also worked to develop and validate the effectiveness of a novel team-based approach to clinical pharmacy services. However, notwithstanding the good medication safety practices observed in adult services, inspectors found that the medication safety programme needed to be further enhanced among paediatric services following this inspection as they do not reach the standards of the adult services.

Clinical audit at Tallaght Hospital was well supported by clinical governance structures, and HIQA found that the hospital had conducted a number of audits relating to medication management. Inspectors found that the hospital had successfully implemented a number of quality improvement initiatives to reduce medication errors. The hospital had a medication safety plan with clear defined goals for 2017. To further build on these positive findings, the hospital should looks to develop a written medication safety strategy that sets out a clearly articulated multidisciplinary vision for medication safety across both adult and paediatric services.

Overall, this inspection found a significant amount of innovative practice that enhanced medication safety and that would be of value for other hospitals to review.

University Hospital Limerick

An announced inspection of University Hospital Limerick took place on 18 May 2017. During this inspection, a wide range of medication safety related risks were identified and communicated to hospital management in writing following the inspection. It was identified that governance arrangements related to medication safety at hospital and group level were fragmented in approach and underdeveloped. Inspectors found inherent weaknesses in the existing medication systems, processes and level of resourcing at the hospital at the time of the inspection. Overall, many of the elements required to improve the safety and quality of medicines use in an acute hospital setting were either in the very early stages of development or not in place.

The hospital formulated a quality improvement plan in response to the identified risks. However, HIQA noted that this plan did not include associated timelines for implementation. HIQA, therefore, determined that, in order to assess progress with the implementation of necessary action across both University Hospital Limerick and the wider the UL Hospitals Group, a follow-up inspection within six months was necessary. HIQA’s intention to carry out this follow-up inspection was communicated to the UL Hospitals Group CEO.

Read the full reports at www.hiqa.ie.

Notes for Editors

• 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’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.