Although Bantry General Hospital had strengthened governance arrangements for medication safety since the last HIQA inspection in 2016, HIQA inspectors identified significant concerns in relation to the overall leadership, governance and management of medication safety during this announced medication safety inspection. Specifically, practices observed did not support safe medication practices and highlighted a lack of risk-reduction strategies in place to ensure safety with the management and the storage of anticoagulant medication.
The hospital did not have a medication safety strategy to direct improvement but a quality improvement plan had been initiated based on the gaps identified in the 2016 medication safety report. Progress had been made on the development of intravenous medication administration guidelines, a preferred medications list (formulary) and auditing aspects of medication safety. Progress had also been made to improve rates of medication incident reporting but analysis and trending of medication incidents should be communicated to front-line staff and used to identify areas for targeted improvement.
A failure to implement recognised medication safety systems such as the provision of a clinical pharmacy services and formalised medication reconciliation, which are essential to ensuring medication safety in clinical settings, were also identified.
Bantry General Hospital did not have comprehensive established systems in place for all high-risk medications which were relevant to the services provided. The hospital had identified high-risk medications in use and had implemented risk-reduction strategies for some medications such as potassium chloride and insulin. However, the management of anticoagulant medications at the time of the inspection did not support safe medication practices and as a result HIQA wrote to the hospital to seek assurances as to how the hospital would address specific risks identified.
Overall, the hospital had acted to strengthen medication safety through medication safety governance arrangements and had implemented some safety initiatives. Medication safety at the hospital was an evolving process but there is scope for further improvement.