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 Our Lady’s Children’s Hospital, Crumlin, in Dublin and at Galway University Hospitals.

In general, these inspections identified good practice related to the establishment of comprehensive medication safety programmes, with Our Lady’s Children’s Hospital performing notably well. These inspections also identified some scope for further development of each hospital’s medication safety programme. In particular, HIQA found that there was further potential for Galway University Hospitals to advance efforts in the area of auditing, reporting medication safety incidents and developing a medication formulary to more systematically manage the introduction of new medicines into practice at the hospital.

Our Lady’s Children’s Hospital, Crumlin, Dublin

An announced medication safety inspection was carried out at Our Lady’s Children’s Hospital, Crumlin, on 25 May 2017. Medication use in children presents some additional safety challenges when compared to other patient populations, and it is, therefore, imperative that effective safety systems are established to protect children against such risks in the hospital setting.

Our Lady’s Children’s Hospital, Crumlin, had an effective medication safety programme in place, supported by strong governance arrangements, systems, processes and medication usage practices. It was evident that this was driven by effective local leadership and executive management support and resource allocation. Moreover, there was evidence that the hospital board actively sought assurance in relation to medication safety.

The Drugs and Therapeutics Committee, on an ongoing basis, objectively appraised, evaluated and selected medications for addition to or removal from the hospital formulary as a baseline risk management measure.

Medication incidents and near misses were tracked and trended by the hospital’s Medication Safety Committee to assess progress, identify emergent medication safety concerns and prioritise medication safety activities. Inspectors identified that medication incident reporting rates in the hospital had increased significantly in recent years. This is a positive finding, and it reflects the emphasis placed on patient safety by the hospital and the willingness of front-line staff to provide information that is ultimately intended to reduce the risks of harm. Numerous high-level error-prevention strategies were used to improve medication safety, with ward-based clinical pharmacists and the increased use of technology, including computerised physician order entry, smart pump infusion technology and the use of smart phone applications.

Our Lady’s Children’s Hospital, Crumlin, was actively collaborating with other hospitals within the Children’s Hospital Group and with regional paediatric centres nationally in order to progress a shared working approach to improving medication safety and in preparation for the opening of the new National Paediatric Hospital.

Galway University Hospitals

An announced medication safety inspection was carried out on 31 May 2017 at Galway University Hospitals, which is made up of University Hospital Galway and Merlin Park University Hospital. Galway University Hospitals had established governance arrangements in place to support medication safety practices. The hospital had an established Drugs and Therapeutics Committee that provided ongoing oversight of the medication management and safety systems within the hospital. The hospital had successfully implemented a number of core medication safety interventions supported by policies. However, inspectors found that the hospital did not have a hospital-wide drug formulary, a formalised audit plan or a medication safety strategy in place. HIQA recommends that, following this inspection an agreed written medication strategy including an audit plan, targeted on the basis of risk, should be developed and implemented by the hospital and shared with the wider Saolta Group.

While the hospital has worked to develop and support a system in place for tracking and trending medication incidents, HIQA found that the hospital expends considerable time and effort on investigating and addressing risk issues as they emerge through reporting. This is a necessary and important endeavour in driving learning for the benefit of patient safety. However, this approach could be enhanced by also focusing a greater degree of effort on improvement of targeted risk areas identified through other means, such as national or international trends. Such an approach may prevent the potential for solely reactive risk management, as opposed to a more strategic broad-based approach to managing known areas of high risk.

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.