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 April 2017 at the National Maternity Hospital, Holles Street, Dublin, Regional Hospital Mullingar, and St Vincent’s University Hospital, Dublin. All three hospitals are members of the Ireland East Hospital Group.

These three inspections identified considerable variation in the arrangements in place in each hospital to ensure medication safety. St Vincent’s University Hospital had a mature and well-developed medication safety programme in place. The National Maternity Hospital at Holles Street had established appropriate protections for the governance and management. However, the inspection at the Regional Hospital Mullingar identified that, notwithstanding recent efforts to begin to improve medication safety governance and establish a medication safety programme, many of the measures which have long been established in other hospitals inspected by HIQA throughout this programme were either not present, or were under developed.

In particular, the hospital lacked the necessary pharmacy resources and should be supported within the Ireland East Hospital Group structure to address identified deficits. For example, greater support and expertise should be made available to the Regional Hospital Mullingar from other hospitals in the group that have more established medication safety programmes to further support necessary improvements.

National Maternity Hospital, Holles Street, Dublin

An announced inspection of the National Maternity Hospital, Holles Street was carried out on 12 April 2017. The hospital has established governance arrangements in place, with systems and processes to support medication safety practices. The medication safety agenda was prioritised at organisational level. However, the hospital did not have a drug formulary (a listing of approved medicines for prescription and use in the hospital) in place to manage the risk associated with introducing new medicines in particular.

The hospital had developed a new risk management database where medication incidents were tracked and trended to assess progress and to identify any emerging medication safety concerns. In addition, inspectors found that the hospital had also implemented a number of quality improvement initiatives to reduce medication errors and had developed a number of medication policies.

A clinical pharmacy service was provided across the hospital. Although this service included the provision of expert advice to prescribers and reviews of inpatient medication prescription charts, medication reconciliation was not formalised or supported by a medication reconciliation policy or audit.

While a number of audits had been completed, the hospital’s current arrangements regarding a strategic audit plan should be strengthened and formalised to provide assurance to the senior management team about medication safety at the hospital.

The hospital reported on the day of inspection that it collaborated with the new hospital group structure and other maternity hospitals. This should be continued to share good practice pertaining to medication safety and to develop and implement policies and practices for medication management.

Regional Hospital Mullingar

An announced inspection of the Regional Hospital Mullingar took place on 20 April 2017. HIQA identified complex risks relating to medication safety during this inspection. Cumulative risks related to the lack of basic systems and processes to underpin an effective medication safety programme. In addition, assurance mechanisms relating to medication safety were underdeveloped. While HIQA acknowledges that medication safety governance structures had recently been strengthened in the hospital, these arrangements could not sufficiently support the implementation of an effective medication safety strategy or plan due to a relative lack of pharmacists.

It was evident during the inspection that more support was required from the Ireland East Hospital Group to assist Regional Hospital Mullingar in addressing deficits relative to many hospitals of its size and service provision, including other hospitals in their group that have much more advanced programmes. Many of the issues identified could be related to a lack of pharmacists compared with other hospitals of similar size providing the same level of complex care.

HIQA recommends that a high-level strategic plan is devised, resourced, implemented and managed by the hospital group to effectively address the issues identified at Regional Hospital Mullingar. This plan should also involve representation from the local Community Healthcare Organisation, given the impact that a requirement for ongoing medication supply functions to community services has on the ability of the hospital to focus on inpatient safety needs.

St Vincent’s University Hospital, Dublin

An announced inspection of St Vincent’s University Hospital, Dublin on 26 April 2017 found that the hospital had established governance arrangements in place with systems, processes and practices to support medication safety at the hospital. It was evident that this had been progressed over a significant period of time, driven by effective local leadership and executive management support and resource allocation.

The Drugs and Therapeutics Committee provided the leadership and structure to select appropriate medications for the formulary and promoted rational drug use. The hospital had a 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. However, the hospital had identified scope for improvement in the degree of error reporting by medical staff.

Evidence was submitted and reviewed which verified that clinical audit activities at the hospital led to changes aimed at improving the delivery of clinical services.

St Vincent’s University 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.

Read the full reports here.

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.