Three 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 March 2017 in Midland Regional Hospital Tullamore, the Rotunda Hospital, Dublin and St Michael’s Hospital, Dun Laoghaire.

In general, HIQA found good medication safety practices in all three hospitals. For example, inspectors found that medication safety was prioritised at organisational level and supported by senior management and staff in each of the hospitals inspected. This had a positive effect on the systems, processes and practices that were in place to support medication safety.

However, despite the fact that most findings were positive, HIQA also found opportunities for learning and improvement in each of the three hospitals inspected. For example, in relation to medication-related incident and near miss reporting, HIQA found that a multidisciplinary approach was needed to increase possible under reporting and to maximise overall learning in all three hospitals.

Rotunda Hospital, Dublin

An announced inspection of the Rotunda Hospital in Dublin was carried out on 22 March 2017. The Rotunda Hospital had established governance arrangements in place with systems, processes and practices to support medication safety in the hospital. It was evident that medication safety had been progressed over a significant period of time, driven by effective local leadership, executive management support and resource allocation. The Drugs and Therapeutics Committee participated in performance improvement activities related to procuring, prescribing, dispensing, administering, monitoring, and overall use of medications.

The hospital had a well-established medication safety programme in place. Medication safety was prioritised at organisational level with clear leadership from the Chief Pharmacist and the support of the Senior Management Team and staff at the hospital.

Inspectors found that the hospital had implemented a number of quality improvement initiatives to reduce medication errors and had developed a number of medication policies. Medication-related incidents and near misses were analysed and actions were taken to address them, with further recommendations made to prevent reoccurrences of such variances. Healthcare staff were aware that the hospital had a medication incident reporting system. However, further scope for improvement was identified by the hospital in the level of near miss reporting.

Clinical audit in the Rotunda Hospital was well supported by, and reported through, the clinical governance structure and was part of a structured organisational quality and risk management programme. The hospital had successfully implemented a number of core medication safety interventions and had a good programme of clinical interaction in place to promote best practice around medication use for patients.

Midland Regional Hospital Tullamore

An announced inspection of Midland Regional Hospital Tullamore took place on 13 March 2017. HIQA found that medication safety was prioritised at organisational level with clear leadership from the Chief Pharmacist and the support of the Senior Management Team, the Pharmacy and Therapeutics Safety Committee, the Medication Safety Committee and staff at the hospital.

The hospital had an established system for reporting and addressing medication errors and near misses, and promoted an open reporting culture for learning from these incidents and near misses. HIQA found that while there was a positive trend in reporting at the hospital, the majority of medication incident reports were submitted by clinical pharmacists. Senior managers need to increase participation in the programme beyond the Pharmacy Department and, in particular, work to promote systematic audit and incident reporting among other clinical staffing groups.

Inspectors found that the hospital had implemented a number of quality improvement initiatives to reduce medication errors and had developed a number of medication policies. In addition, the hospital had conducted a number of audits relating to medication management. However, the hospital needs to implement a structured approach to auditing medication aligned to a formalised medication safety strategy.

St Michael’s Hospital, Dun Laoghaire

An announced inspection of St Michael’s Hospital, Dun Laoghaire on 29 March 2017 found the hospital had an established Drugs and Therapeutics Committee in place. Systems, processes and practices were in place to support medication safety, some of which were currently under development. HIQA found that medication safety was prioritised at organisational level with clear leadership from the Chief Pharmacist and the support of the Drugs and Therapeutics Committee, the medication safety sub-committee and staff.

However, inspectors found scope for improved clarity around on-site clinical leadership during this inspection, which needs to be addressed by the hospital.

The hospital had an established system for reporting and addressing medication errors and near misses, and promoted an open reporting culture for learning from medication-related incidents and near misses. HIQA found that learning from incidents was documented and shared with all clinical areas. However, inspectors identified that medication-related incidents were likely under reported at the hospital.

HIQA found that assurances relating to the effectiveness of the medication safety programme were developing, with an increased focus on medication-related clinical audits planned for 2017. Scope for improving the process of medication reconciliation was identified in St Michael’s Hospital. The hospital should ensure that medication reconciliation is carried out in a structured manner by trained and competent health professionals with the necessary knowledge, skills and expertise. Moreover, audit into the effectiveness of local arrangements around medicines reconciliation should be further explored.

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.